Short-segment intestinal interposition of the distal esophagus

Area of Science:

• Gastroenterology
• Surgical Oncology
• Digestive System Surgery

Background:

• Esophageal replacement is a complex surgical challenge.
• The stomach is not always a suitable conduit for esophageal replacement.
• Colon and jejunum are alternative options for esophageal substitution.

Purpose of the Study:

• To evaluate the outcomes of short-segment interposition of the esophagus using colon or jejunum.
• To compare complication rates and functional results between colon and jejunal interpositions.
• To assess the long-term efficacy of these procedures for esophageal replacement.

Main Methods:

• A retrospective review of 41 patients undergoing esophageal interposition with colon or jejunum between 1971 and 1991.
• Analysis of indications, including failed antireflux procedures, strictures, achalasia, and cancer.
• Assessment of major complications, hospital mortality, and late functional outcomes with a mean follow-up of 87 months.

Main Results:

• Major complications occurred in 45% of colon interpositions and 31% of jejunal interpositions.
• Hospital mortality was 4.5% for colon and 10.5% for jejunum.
• Excellent or good late functional results were achieved in 76.5% of patients (26/34).

Conclusions:

• Esophageal replacement with colon or jejunum can successfully palliate swallowing difficulties when the stomach is unsuitable.
• Both procedures carry risks, with jejunal interposition having higher hospital mortality and colon interposition having more major complications in this series.
• Surgeons managing esophageal diseases should be proficient in both jejunal and colon interposition techniques.