MID-COLON OESOPHAGOCOLOPLASTY FOR CORROSIVE OESOPHAGEAL STRICTURES

Corrosive strictures of the oesophagus are common and being long and dense frequently require surgical replacement of the oesophagus. Presently available techniques of oesophagocoloplasty are associated with a significant mortality and major morbidity, such as a high rate of ischaemic necrosis of the colon, cervical salivary fistula or oesophagocolic stenosis. A method of mid-colon oesophagocoloplasty using an isoperistaltic colonic segment from the mid-ascending to the mid-descending colon is reported. The procedure was carried out in 33 patients. The conduit was placed retrosternally in 27 patients and subcutaneously in the rest. The essential steps of the procedure are simultaneous neck and abdominal dissection, near-total mobilization of the colon from the ileocaecal segment to the sigmoid colon and sequential clamping of ileocolic, right colic and usually the middle colic vessels leaving the left colic vessels as the major vascular pedicle. The divided ileum is used to pull the colon into position thus avoiding traumatization of the colon and leaving the whole length of the mobilized colon available for anastomosis. A wide side to side oesophagocolic anastomosis in the neck, resection and discarding of the bulky terminal ileocaecal segment after completion of the cervical anastomosis, closure of the terminal end of the colon and its placement adjacent to the hypopharynx and end to side cologastric anastomosis complete the procedure. There was no mortality and there was no instance of colonic necrosis. The procedure restored an ability to eat normal food in 93.9% of patients compared to only 39.2% of patients with bougienage. The major advantages of this procedure are a uniformly adequate length of colon, excellent vascularity, avoidance of a potentially ischaemic colonic end in the oesophagocolic anastomosis, with its attendant sequelae such as cervical fistulae or oesophagocolic stenosis, low incidence of complications and the possibility of easy correction of oesophagocolic stenosis should it occur after the procedure. Cervical fistulae occurred in 10 patients and spontaneously closed in nine. Cervical anastomotic stenosis occurred in only one instance. The functional results and complication rate reported here are superior to most other series of oesophagocoloplasty for corrosive strictures reported in the literature. The operation is technically easy and is a significant improvement on existing methods of oesophageal replacement.