[Esophageal replacement by interposition of pedicled ascending colon flap supplied by the inferior mesenteric artery].

OBJECTIVE

Colon interposition for esophageal replacement is indicated in patients with benign esophageal disease, in patients who require an esophago gastrectomy for a potential cure and in patients in whom the stomach is no longer available for replacement because of preceding surgery.

METHODS

In 30 patients we performed colon interposition grafts for esophageal replacement using a modified technique. This technique includes ligation of the middle and right colic artery, thereby creating an interposition graft of the whole ascending colon which receives blood exclusively from the left colic artery. The main advantage of this procedure is the length of the interposition graft. Preparation of the left colic flexure is no longer required. Nineteen patients had an esophagectomy, 11 patients an esophago-gastrectomy.

RESULTS

Minor complications in this unselected patient group occurred six times (20%), and major complications were observed in seven patients (23.3%). Frequency of anastomotic leakage amounted to 13.3%, hospital mortality to 10%.

CONCLUSION

Frequency of postoperative complications and hospital mortality of patients in whom a modified colon interposition was done is comparable with published data of unselected patient groups, which had either a standard colon interposition graft for esophageal replacement or a gastric pull-through procedure.