Minimally Invasive Left Colonic Interposition For Corrosive Esophageal Stricture: Technique and Outcomes.

Area of Science:

• Gastroenterology and Hepatology
• Surgical Oncology
• Digestive System Surgery

Background:

• Corrosive ingestion commonly causes upper aerodigestive tract strictures, necessitating surgical intervention.
• The optimal surgical strategy for managing these strictures remains a subject of debate.
• Colonic interposition is explored as a potential reconstructive approach.

Purpose of the Study:

• To evaluate the safety and efficacy of left colonic interposition for esophageal reconstruction in patients with corrosive strictures.
• To assess both short-term and long-term functional outcomes following the procedure.

Main Methods:

• Retrospective review of 21 patients undergoing left colonic interposition for corrosive esophageal strictures (2017-2024).
• Procedures included cervical dissection, colonic mobilization, retrosternal tunnel creation, and reconstruction.
• Surgical approaches included fully open (4 patients) and laparoscopic colon mobilization with retrosternal tunnel creation (17 patients).

Main Results:

• The study included 21 patients (mean age 37 years, 14 males), with strictures present for over a year, and 14 malnourished.
• Laparoscopic procedures had longer operative times (361 min) compared to open surgery (294 min).
• All patients achieved oral feeding by postoperative day 2, with feeding jejunostomy removal at 1 month. Median follow-up was 30 months, with all patients maintaining normal oral intake and surviving.

Conclusions:

• Left colonic graft interposition is a safe and effective method for esophageal reconstruction in caustic strictures.
• The technique, especially laparoscopically, is complex and requires careful attention to graft length, vascularity, and isoperistaltic anastomosis for successful outcomes.