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. 2017 Mar;6(2):137-143.
doi: 10.21037/acs.2017.03.07.

Alternative conduits for esophageal replacement

Ankur Bakshi  1 , David J Sugarbaker  1 , Bryan M Burt  1
Affiliations

Alternative conduits for esophageal replacement

Ankur Bakshi et al. Ann Cardiothorac Surg. 2017 Mar.

Abstract

Replacement of the native esophagus after esophagectomy is a problem that has challenged surgeons for over a century. Not only must the conduit be long enough to bridge the distance between the cervical esophagus and the abdomen, it must also have a reliable vascular supply and be sufficiently functional to allow for deglutition. The stomach, jejunum, and colon (right, left or transverse) have all been proposed as potential solutions. The stomach has gained favor for its length, reliable vascular supply and need for only a single anastomosis. However, there are times when the stomach is unavailable for use as a conduit. It is in these instances that an esophageal surgeon must have an alternative conduit in their armamentarium. In this paper, we will briefly discuss the technical aspects of jejunal and colonic interposition. We will review the recent literature with a focus on early and late outcomes. The advantages and disadvantages of both options will be reviewed.

Keywords: Esophagectomy; Roux-en-Y jejunostomy; colon interposition; esophageal; jejunum.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Isoperistaltic right colon interposition. (A) Creating of the interposition graft; (B) construction of the cervical anastomosis; (C) reconstruction of intestinal continuity. Source: Fürst et al. (5).
Figure 2
Figure 2
Right colon interposition graft prior to delivery through the mediastinum and cervical anastomosis. Source: Bryan M. Burt, MD.
Figure 3
Figure 3
Vascular arcade pattern of the jejunum and division of the vasculature and mesentery for creation of the jejunal conduit. Source: Blackmon et al. (22).
See this image and copyright information in PMC

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