Using right colon interposition in patients with caustic ingestion, an introduction of a new surgical technique for post-gastrectomy reconstruction: a case series.

Abstract

Background: Corrosive substance ingestion is rare but can cause severe injury, especially to the upper gastrointestinal tract, and can be a potentially fatal event. Various surgical procedures have been advocated for gastroesophageal reconstruction, but especially those using the right colon, when the ileocecal valve is preserved for gastric reconstruction, are briefly exposed in literature and have not been studied in humans by controlled studies. Using the right colon is believed to be beneficial because of the anti-reflux mechanism of the ileocecal valve. This study aims to report our experience in the use of right colon interposition for gastric reconstruction in the management of caustic injury, and to assess its influence on patient outcomes.

Case presentation: We describe five cases, all of which included corrosive substances ingested by patients referred to a local tertiary center institution undergoing right colon interposition for esophageal and gastric reconstruction. We evaluated five Iranian patients undergoing ileocolic segment interposition for gastric reconstruction. Of these, two were male patients (patient 1 was 51 years old, patient 2 was 32 years old), and three were female patients (patient 3 was 49 years old, patient 4 was 32 year old, patient 5 was 59 year old), with an age from 32 to 59 years (mean: 57 ± 10.95). The operating surgeon's first to fifth procedures proceeded uneventfully, with only one case of cervical leakage as a complication with spontaneous closure; relative mean operative time of 5.95 ± 1.17 hours, hospital stays of 25 ± 15.29 days for all five patients. No excess morbidity rate was observed.

Conclusion: In this case series, a novel technique for post-gastrectomy reconstruction using right colon interposition along with an ileocecal reservoir with identical advantages in improving eating capacity, and avoiding biliary reflux thanks to the presence of the ileocecal valve, is introduced.