How to ensure immediate and long-term good blood supply by the careful dissection of the marginal artery and supercharge with neck vessels in esophageal reconstruction with the colon segment interposition: 35 years of experience.

Abstract Background Colon interposition for total esophageal replacement cases represent one of the most challenging procedures in surgery. A retrospective study has been conducted and suggestions are proposed according to the analysis of 268 patients who underwent colon interposition for esophageal replacement. Complication rates and duration of hospital stay were retrospectively analyzed. Methods 268 patients were operated between 1984 and 2018. 164 patients (group 1) underwent colon interposition without supercharging with neck vessels, and 104 patients (group 2) with supercharging. Data regarding flap loss, anastomotic leakage, duration of hospital stay and stricture formation in long-term were statistically analyzed and compared between two groups. Results The success rate of reconstruction was 98,1% (161 of 164 patients) and 99% (103 of 104 patients) for group 1 and 2, respectively. Early complication (anastomotic leakage) rate was 4,9% in group 1, and 1% in group 2. The differences between two groups regarding flap loss and anastomotic leakage rates were not statistically significant (p=0,495 and p=0,077, respectively). The hospital stay was 26,3 days for patients without supercharging (group1) and 20,5 days for patients with supercharging (group 2). 6,7% (11/164) of patients in group 1 had narrowing at the junction of pharynx and colon, however in group 2 proximal anastomotic stricture formation was observed in only 1% (1/104) of the patients. Stricture rate was significantly lower in group 2, when compared to group 1 (p=0,021). Conclusion Careful dissection of marginal artery and supercharging with neck vessels provide lower complication rates in colon interposition for esophageal reconstruction.