ESOPHAGOCOLOPLASTY FOR CONGENITAL, BENIGN AND MALIGNANT DISEASES - SURGICAL AND LONG-TERM FUNCTIONAL RESULTS

Objective. Aim of this report is to evaluate the results of 100 consec utive esophagocoloplasties performed for congenital, benign and malign ant diseases. Methods. From 1982 until 1993 one hundred consecutive es ophagocoloplasties 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 vascu larized by the ascending branch of left colic artery and in 95 the rec onstruction was fashioned in isoperistaltic way. Results. Fifty one co mplications 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 hig her in group A+C as compared to group B (p<0.0009). Anastomotic leak w as the most frequent complication occurring in 13 patients however hea ling spontaneously in 11 patients (84.6%). Early revisional surgery wa s performed in 11 patients. Functional results were evaluated accordin g to a new grading system, includ ing the four main symptoms (dysphagi a, pain, regurgitation, diarrhoea) and weight status, the latter for a dult 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 p ediatrics (0.18 years) and 26 adult patients (>18 years). Anastomotic stenosis accurred in 19 patients but resolved after one or more dilata tions in 16 at final follow-up. Dysphagia decreased from 43.1% 3 month s postoperatively to 17.6% at last follow-up (p<0.01). In adult patien ts there was a strong correlation between dysphagia and weight loss (p <0.02). This correlation was not found in children. No differences wer e detectable when comparing preoperative 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 followup (p<0.0001). Only one patient had an un satisfactory final result. Conclusions. Esophagocoloplasty is a valuab le and for some patients an essential technique in reconstruction of e sophageal continuity. Mortality can be kept very low, especially in be nign diseases, guaranteeing satisfactory results in the majority of pa tients, despite an initial substantial perioperative morbidity.