Peculiarities of intra-thoracic colon interposition-eso-coloplasty: indications, surgical management and outcomes

Abstract

Stomach is the usual organ of choice for oesophageal replacement. Gastric pull-up is a standardized, fast and secure procedure, requiring only one anastomosis and usually performed with mini-invasive techniques. Colon is used when the stomach is not available, for tumours of the upper oesophagus or the hypopharynx, for benign or paediatric diseases. It is a complex surgery requiring a specific pre-operative management, three or four anastomoses, and a careful choice of the route of reconstruction. Early post-operative complications, such as anastomotic leakage, are frequent. Long-term outcomes are marked by strictures of the anastomosis and redundancy, but the reported quality of life of the patients is good. Eso-coloplasty remains a safe and feasible alternative to gastric pull-up for oesophageal replacement, for specific indications.

Keywords: Esophagectomy; colon interposition; coloplasty; gastric pull-up; redundancy.

Figure 1

Subtotal esophagectomy associated with a gastrectomy for cancer.

Figure 2

Short and long colon transplants and their associated vascularisation. (A) Short transverse colonic transplant; (B) long right colic transplant with the distal ileum; (C) long left colic transplant. 1, middle colic artery; 2, left colonic vessels.

Figure 3

The correct vascularisation of the chosen transplant is checked by trans-illumination of the meso for identification of the vascular supplies.

Figure 4

The different routes of reconstruction. (A) The colic transplant is placed through the posterior mediastinum; (B) the transplant is retro-sternal; (C) the colon is placed in front of the sternum, sub-cutaneously.

Figure 5

Retro-sternal Route. (A) The retro-sternal route is divided manually from the abdomen and the cervicotomy; (B) the coloplasty is pulled toward the neck; (C) pediatric case.

Figure 6

Dissection of the sternal sub-cutaneous zone for a pre-sternal coloplasty.

Figure 7

The length of the transplant is checked before it is positioned through a retro-sternal route.

Figure 8

Eso-colic cervical anastomosis. (A) The distal extremity of the colon is placed into the neck without tension; (B) posterior running stitch; (C) the anterior running stitch is completed.