Colon interposition for esophageal replacement: Isoperistaltic or antiperistaltic? Experimental results

Background. Isoperistaltic colon is preferred to antiperistaltic colon for esophageal replacement, but experimental data do not exist to support this practice. Methods. In 7 dogs a 20 cm long colon loop was interposed between the skin and the small bowel, isoperistaltically in 3 dogs and antiperistaltically i n 4 dogs. Three months later five strain-gauges were implanted and evacuati on was investigated by motility testing, barium studies, and scintigraphy. Results. Motility recording showed normal colon motility in the excluded lo ops. Quiescent states (duration 40.2 +/- 13.6 minutes) were followed by con tractile states (duration 7.5 +/- 2.4 minutes, frequency 3.3 +/- 0.6 per mi nute). The main peristaltic direction of isoperistaltic loops was isoperist altic, and the main peristaltic direction of antiperistaltic loops was anti peristaltic. Evacuation took place exclusively during the contractile statu s. Half time emptying was more rapid in isoperistaltic loops (35 +/- 11 vs 69 +/- 16 minutes). The content of antiperistaltic loops was held back by a ntiperistaltic activity. Application of oatmeal porridge into the loops sho rtened the quiescent status from 40.2 to 13.2 +/- 4.8 minutes. Conclusions. The colon graft for esophageal replacement is an active system . Food is stored during the quiescent states and evacuated during the contr actile states. The original peristaltic direction is preserved so that retr operistalsis in antiperistaltic loops may lead to patient discomfort and pu lmonary complications. (Ann Thorac Surg 2001;71:303-8) (C) 2001 by The Soci ety of Thoracic Surgeons.