Colon patch esophagoplasty: an alternative to total esophagus replacement?

Area of Science:

• Gastroenterology
• Surgical Innovation
• Esophageal Surgery

Background:

• Resistant benign esophageal strictures often necessitate esophageal replacement.
• Colon patch esophagoplasty (CPE) was initially described for long-segment strictures, with concerns about its applicability to shorter lengths.

Purpose of the Study:

• To evaluate the efficacy of CPE for both long and short benign esophageal strictures.
• To present outcomes of CPE in patients with resistant esophageal strictures.

Main Methods:

• A retrospective study of four patients undergoing CPE using a vascularized right colon patch.
• Surgical technique involved placing the patch in the right pleural cavity and suturing it to a longitudinal esophagotomy beyond the stricture.

Main Results:

• All four male patients, with strictures of varying lengths and causes (caustic, post-atresia repair), experienced normal eating and growth post-surgery.
• Three patients had anastomotic leaks managed conservatively; one required fundoplication. A patch diverticulum occurred in one patient and was resected years later.
• Follow-up ranged from 4-20 years, with no malignant changes observed.

Conclusions:

• Stricture length is not a limiting factor for CPE.
• CPE is a viable alternative to esophageal replacement for resistant benign esophageal strictures.
• Fundoplication and supportive therapy can manage postoperative leaks.