Esophagocoloplasty in the Management of Postcorrosive Strictures of the Esophagus

Abstract

The clinical data, technical considerations, early and late post-operative complications, and long-term follow-up results of esophagocoloplasty in the management of 176 patients with postcorrosive stricture of the esophagus are presented. All 176 colon segments were placed in the isoperistaltic position. Left colon transplants were used in 66.47% and the right colon with terminal ileum was used in 33.52% of patients. The postoperative mortality rate in the entire series was 5.68%. In the past 10 years the postoperative mortality rate was reduced to 1.96%. Long-term follow-up examinations were done for 144 patients (81.81%). Excellent results were noted in 87.50%, satisfactory results in 10.41%, and poor results in 2.08% of surgically treated patients at regular yearly check-ups during a follow-up period ranging from 1 to 24 years after operation.

Corrosive Injury of the Upper Gastrointestinal Tract: A Review

“…In most instances it is possible to bring up the esophageal substitute via a substernal route and perform the proximal anastomosis in the neck or pharynx. Esophageal bypass avoids the need to dissect out a densely scarred esophagus with the attendant risk of injury to the great vessels, thoracic duct, and the trachea or left main bronchus and the inevitable consequence of vagal injury [61][62][63][64][65].…”

“…The magnitude of the risk is debated, but it is alleged that the risk is 1000 times that of the general population. It tends to occur many years after the injury, often more than 30 years later [4,16,[61][62][63][64][65]. Resection of the esophagus after transmural caustic injury can be a formidable undertaking and an increased mortality as a consequence of attempted resection outweighs the theoretical advantage of reducing the cancer risk.…”

“…Thoracotomy is usually required because the dense periesophageal scarring, as a result of both the injury itself and possibly superimposed microperforations from numerous dilatations may be difficult and dangerous to resect via the transhiatal route. Hence if esophagectomy is to be performed, it should be done in a high-volume center where experienced surgeons and intensive care is available [4,8,16,[61][62][63][64][65].…”

“…Gastric pull-up requires only one anastomosis, is generally quicker, and is increasingly being performed laparoscopically. However, the functional results tend to deteriorate over time with the development of symptomatic reflux, stricture, and columnar metaplasia above the anastomosis in the proximal esophageal remnant [4,8,16,[62][63][64][65][66][67]. In contrast, colon interposition is a more extensive procedure that requires three anastomoses, but the functional results remain stable or improve with time.…”

Nutritional management after colonic interposition

“…[6][7][8] In oesophageal reconstruction, six to 12 months is the recommended waiting period, from the time of caustic ingestion until surgery to allow complete scarring of the oesophagus. 2,9 It is essential that adequate nutrition be maintained during this period to ensure optimal postoperative wound healing, and a PEJ is invariably placed preoperatively and maintained postoperatively until the patient is able to consume adequate nutrition orally without complications.…”