Complications of Oesophagoplasty with Isoperistaltic Transverse Colon

Abstract

An analysis is presented of late results in 144 reconstructions of oesophagus with transplants (137 isoperistaltic, 7 anisoperistaltic) from transverse colon for correction of stricture, mainly after corrosive trauma. The grafts were interposed retrosternally in 126 cases and intrathoracically in 18. Delayed passage due to excessive size of the colon segment was managed in four cases by plication of the intra-abdominal part of the graft or by jejunal by-pass. 'Pseudo-diverticulum' at the proximal anastomosis occurred in five cases as a complication of the standard by-pass procedure. Correction was made by closure of the pouching oesophagus below the cervical anastomosis. Transformation to end-to-end anastomosis is also recommended. The incidence of gastrocolic reflux was low. In two of the four observed cases the cause was late pyloric stenosis. There was no case of peptic ulceration. For good late results of colo-oesophageal reconstruction, appropriate length and type of colon segment, suitable site of gastric implantation and isoperistalsis are of primary importance.

A Simple Antireflux Barrier for Cologastric Anastomosis in Colonic Interposition

“…Although low gastrocolic reflux rates were reported in various series (1)(2)(3)(4)(5), this complication may induce serious problems such as distal colonic perforation due to peptic ulceration of the distal colon, or aspiration pneumonia, sepsis, possibly leading to death (6). In addition, massive gastrocolic reflux can impair the healing process at the proximal oesophagocolonic anastomosis in the early postoperative period as in our case.…”