Late Complications of Colon Interposition for Esophageal Reconstruction

Abstract

Introduction: Successful restoration of digestive continuity following esophagectomy is a challenge. Gastric graft remains is the first option to reconstruct diseased esophagus. However, colon graft is preferable in some instances. Colon interposition is a complex and more demanding surgical procedure. The long-term functional results of colon interposition were satisfactory and can be subsequently affected by late complications. We reported in this retrospective study, the late complications occurred after left colon interposition performed for esophageal caustic stricture from 2000 to 2016. Patients and Methods: Sixteen of 107 patients who received left colon interposition for esophageal caustic stricture developed a late complication. There were 15 women and one man with median age of 20 years. Three patients had a previous cervical leak and thoracic inlet was widened in 2 cases. Results: The late post-operative morbidity rate was 14.9%. Cervical anastomotic stricture occurred in 8 patients. Dilations were successful in 6 patients and surgical revision was required in 2 patients. Symptomatic mild gastrocolic reflux occurred in 5 patients and Symptoms improvement had been obtained after medical treatment and lifestyle modification. Two patients developed graft redundancy and surgery was required after failure of life-style modification measures. It consisted of resecting the redundant colon and performing an end-to-end anastomosis. Conclusion: Late complication after colon interposition can greatly affect swallowing function and quality of life. Surgery is required in some conditions to improve symptoms and life-quality. Identification of predisposing factors and improvement in technique remain the best way to reduce the risk of late complications.