Minimally Invasive Left Colonic Interposition For Corrosive Esophageal Stricture: Technique and Outcomes.

Background: Corrosive ingestion frequently leads to upper aerodigestive tract strictures, with the optimal surgical approach debated. This study investigates the safety and effectiveness of colonic interposition for this condition.

Methods: We retrospectively reviewed 21 patients with corrosive-induced esophageal stricture who underwent left colonic interposition between 2017 and 2024. Procedures involved cervical dissection, colonic mobilization, retrosternal tunnel creation, and reconstruction. Four patients underwent fully open surgical procedures, and 17 patients underwent laparoscopic colon mobilization and retrosternal tunnel creation. Outcomes included surgical complications and short-term and long-term feeding function.

Results: The mean age was 37 years, with a male predominance (14/21 patients). All had esophageal stricture secondary to chemical burn for >1 year, and 14 were malnourished. Stricture locations were cervical (5 patients), upper third (8 patients), middle third (8 patients), and lower third (3 patients). Laparoscopic surgery had longer mean operative times than open surgery (361 vs. 294 min). One patient developed gastric outlet obstruction due to an undiagnosed pyloric stenosis. All patients resumed oral feeding by postoperative day 2, and feeding jejunostomy were removed at 1 month. During a median 30-month follow-up, all maintained normal oral intake and survived.

Conclusions: Left colonic graft interposition for esophageal reconstruction in caustic strictures is safe and effective. However, the technique is complex, particularly laparoscopically. Adequate graft length, vascularity, and isoperistaltic anastomosis are crucial for success.