Hand-assisted laparoscopic colon mobilization for esophageal reconstruction

New techniques for hand-assisted laparoscopic colon surgery have been adopted quickly for the treatment of numerous colorectal diseases. However, reports of laparoscopic colonic mobilization for esophageal reconstruction are rare. In this report we describe an improved procedure for esophageal reconstruction with transverse colon.

From January 1999 to April 2001, we recruited seven patients (5 women and 2 men) who acquired esophageal stricture after swallowing hydrogen chloride or lye. The mean age of the patients was 42.7 years. For surgery, the patients were placed in lithotomy position under single-lumen intubated anesthesia. First, hand-assisted laparoscopic colon mobilization was performed with the assistance of the Harmonic Scalpel (AutoSuture Company, Norwalk, CT, USA) through a 7-cm upper abdominal incision. Then using cervical esophagocolostomy through the retrosternal route, coloenterostomy and colocolostomy were achieved.

The mean operative time was 3.9 h (range, 3.2-5 h). The mean hospital stay was 9.1 days (range, 8-13 days). Mean blood loss was 100 ml (range, 50-350 ml). All the patients obtained successful outcomes. There was one mild abdominal wound infection, and no surgical mortality. At this writing, the seven patients can eat solid food very well after a mean follow-up period of 18.2 months.

Hand-assisted laparoscopic colonic mobilization for esophageal reconstruction is a safe and feasible operation for treating patients with esophageal stricture.