[Colonic esophagoplasty for benign lesions]

Area of Science:

• Gastroenterology
• Surgical Oncology
• Thoracic Surgery

Context:

• Benign esophageal diseases necessitate complex reconstructive procedures.
• Esophageal replacement is a critical intervention for conditions like atresia, reflux esophagitis, and caustic stenosis.
• Surgical techniques for esophageal reconstruction have evolved to improve patient outcomes.

Purpose:

• To evaluate the outcomes of esophageal replacement using various colon segments in patients with benign esophageal diseases.
• To analyze surgical techniques, including substernal vs. posterior mediastinal placement and types of anastomosis.
• To assess hospital mortality, morbidity, and long-term functional results following esophageal replacement.

Summary:

• This study reviewed 68 patients undergoing esophageal replacement for benign conditions, utilizing ileocolon, transverse, or left colon grafts.
• Procedures involved either bypass without esophagectomy or interposition with esophagectomy, with cervical or thoracic superior and gastric, duodenal, or jejunal inferior anastomoses.
• Hospital mortality was 8.8%, morbidity 57.3%, with 68% of survivors achieving near-normal function, though 18 required reoperation.

Impact:

• Colon interposition offers a viable option for esophageal reconstruction in benign diseases, achieving satisfactory long-term function in a majority of patients.
• Understanding the complication rates and reoperation needs is crucial for patient counseling and surgical planning.
• The study highlights the importance of surgical technique and anastomosis type in influencing outcomes after esophageal replacement.