Colon interposition graft for corrosive esophageal stricture: midterm functional outcome

Area of Science:

• Gastroenterology
• Surgical Oncology
• Digestive System Surgery

Background:

• Corrosive esophageal stricture is a significant cause of morbidity in Nigeria, often resulting from sodium hydroxide ingestion.
• Treatment options for esophageal stricture vary, with pedicled colonic interposition being a reviewed technique.

Purpose of the Study:

• To review the outcomes of a 10-year experience with pedicled colonic interposition for corrosive esophageal stricture.
• To evaluate the efficacy and complications of this surgical approach.

Main Methods:

• A retrospective study of 21 patients undergoing substernal isoperistaltic pedicled colonic interposition.
• The procedure involved pulling the right colon into the neck without resecting the strictured esophagus.

Main Results:

• Indications included long-segment and multiple strictures. Mean procedure time was 339.6 minutes with average blood loss of 673.1 mL.
• Hospital mortality was 9.5%. Complications included graft infarction (9.5%), cervical fistulae (19.0%), and reflux neo-esophagitis (14.3%).
• Mid-term follow-up showed dysphagia relief in over 84% of patients, with no gross regurgitation or nocturnal aspiration.

Conclusions:

• Pedicled colonic interposition provides good mid-term functional outcomes and dysphagia relief.
• High early postoperative morbidity is noted, with graft infarction being a critical factor for poor outcomes.
• Preventing graft infarction is essential for improving functional results in managing corrosive esophageal stricture.