MID-COLON OESOPHAGOCOLOPLASTY FOR CORROSIVE ESOPHAGEAL STRICTURES

Corrosive strictures of the oesophagus are common and being long and d ense frequently require surgical replacement of the oesophagus. Presen tly available techniques of oesophagocoloplasty are associated with a significant mortality and major morbidity, such as a high rate of isch aemic necrosis of the colon, cervical salivary fistula or oesophagocol ic stenosis. A method of mid-colon oesophagocoloplasty using an isoper istaltic colonic segment from the mid-ascending to the mid-descending colon is reported. The procedure was carried out in 33 patients. The c onduit was placed retrosternally in 27 patients and subcutaneously in the rest. The essential steps of the procedure are simultaneous neck a nd abdominal dissection, near-total mobilization of the colon from the ileocaecal segment to the sigmoid colon and sequential clamping of il eocolic, right colic and usually the middle colic vessels leaving the left colic vessels as the major vascular pedicle. The divided ileum is used to pull the colon into position thus avoiding traumatization of the colon and leaving the whole length of the mobilized colon availabl e for anastomosis. A wide side to side oesophagocolic anastomosis in t he neck, resection and discarding of the bulky terminal ileocaecal seg ment after completion of the cervical anastomosis, closure of the term inal end of the colon and its placement adjacent to the hypopharynx an d end to side cologastric anastomosis complete the procedure. There wa s no mortality and there was no instance of colonic necrosis. The proc edure restored an ability to eat normal food in 93.9% of patients comp ared to only 39.2% of patients with bougienage. The major advantages o f this procedure are a uniformly adequate length of colon, excellent v ascularity, avoidance of a potentially ischaemic colonic end in the oe sophagocolic anastomosis, with its attendant sequelae such as cervical fistulae or oesophagocolic stenosis, low incidence of complications a nd the possibility of easy correction of oesophagocolic stenosis shoul d it occur after the procedure. Cervical fistulae occurred in 10 patie nts and spontaneously closed in nine. Cervical anastomotic stenosis oc curred in only one instance. The functional results and complication r ate reported here are superior to most other series of oesophagocolopl asty for corrosive strictures reported in the literature. The operatio n is technically easy and is a significant improvement on existing met hods of oesophageal replacement.