Late complications of coloesophagoplasty and long-term features of adaptation

Abstract

This experience attests that the majority of late complications following colonic esophageal substitution may be corrected by revisional surgery. The predominantly automatic propulsive movements of the isoperistaltically interposed grafts seem to provide an effective antireflux barrier against the gastrocolic reflux if some technical requirements (high gastric anastomosis, good gastric drainage, etc.) are respected. The graft mucosa showed signs of a positive adaptation. The best functional results were achieved by isoperistaltically interposed left colic transplants, which may be considered as an ideal graft (both technically and functionally) in extensive caustic strictures.

Surgical management of failed colon interposition☆

“…They also confirmed a higher incidence of long-term complications in long-segment colon interposition. Kotsis and colleagues reported 19 re-operations in 141 colon interpositions for corrosive injury [9].…”

“…Our series is not inclusive of all complications known to occur after colon bypass. Colonic fistulas, perforated diverticulitis, pseudodiverticulum and colon cancer have been reported [9][10][11][12]. Retrospective data analysis of highly selected patients introduces several biases to our results and analysis.…”

Surgical treatment of late dysfunction of an esophagocoloplasty

“…Nonetheless, it is a complex and delicate intervention, characterized by elevated operative morbidity and by the late occurrence of complications that can sometimes require complex and repeated revisions [1][2][3][4][5][6][7][8][9][10][11][12]. These late complications, often due to technical flaws at the original surgery, must be distinSurgical treatment of late dysfunction of an esophagocoloplasty e397 guished from the functional results and quality of life, both of which are excellent in most cases [1,2,6]. The rate of late complications after esophagocoloplasty can reach 55% [3] and the need for revisional surgery for these complications ranges from 15 to 50% [1][2][3].…”

Right colectomy with isoperistaltic side-to-side stapled ileocolic anastomosis

“…In extensive caustic strictures of the esophagus best functional results are achieved by isoperistaltically interposed left colic transplants [3]. The predominantly automatic propulsive movements of the isoperistaltically interposed grafts seem to provide an effective antireflux barrier against the gastrocolic reflux if some technical requirements (high gastric anastomosis, good gastric drainage, etc.)…”

“…The predominantly automatic propulsive movements of the isoperistaltically interposed grafts seem to provide an effective antireflux barrier against the gastrocolic reflux if some technical requirements (high gastric anastomosis, good gastric drainage, etc.) are respected [3]. Zorn et al [4] reported two cases that were referred to their institution with recurrent cholangitis after biliary reconstruction, highlighting the devastating consequences of antiperistaltic construction of the Roux limb.…”