Esophagocoloplasty for congenital, benign and malignant diseases. Surgical and long-term functional results

Aim of this report is to evaluate the results of 100 consecutive esophagocoloplasties performed for congenital, benign and malignant diseases.

From 1982 until 1993 one hundred consecutive esophagocoloplasties were performed. Fifty eight for benign diseases: 22 congenital atresias (group A), 36 acquired benign lesions (group B), and 42 for malignancy (group C). As 72% of the patients had undergone previous gastric or esophageal surgery, coloplasty had to be performed in 48 patients by necessity. In 85 patients the colon graft was vascularized by the ascending branch of left colic artery and in 95 the reconstruction was fashioned in isoperistaltic way.

Fifty one complications occurred in 42 patients resulting in a hospital mortality of 8%. However, for all benign diseases (group A + B) mortality rate was 0, being 19% in malignancy (group C). Morbidity was significantly higher in group A + C as compared to group B (p < 0.0009). Anastomotic leak was the most frequent complication occurring in 13 patients however healing spontaneously in 11 patients (84.6%). Early revisional surgery was performed in 11 patients. Functional results were evaluated according to a new grading system, including the four main symptoms (dysphagia, pain, regurgitations, diarrhoea) and weight status, the latter for adult patients. Fifty one patients from group A and B were followed for at least one year and evaluated. The were divided in two groups: 25 pediatrics (0.18 years). Anastomotic stenosis occurred in 19 patients but resolved after one or more dilatations in 16 at final follow-up. Dysphagia decreased from 43.1% 3 months postoperatively to 17.6% at last follow-up (p < 0.01). In adult patients there was a strong correlation between dysphagia and weight loss (p < 0.02). This correlation was not found in children. No differences were detectable when comparing preoperative mean weight of adult patients with mean weight of adult patients with mean weight at last follow-up. Of all 51 patients, 82.3% had an excellent (grade 1) or very good (grade 2) result at final evaluation versus 49% at 3 months follow-up (p < 0.0001). Only one patient had an unsatisfactory final result.

Esophagocoloplasty is a valuable and for some patients an essential technique in reconstruction of esophageal continuity. Mortality can be kept very low, especially in benign diseases, guaranteeing satisfactory results in the majority of patients, despite an initial substantial perioperative morbidity.