15-year Personal Experience of Esophageal Reconstruction by Left Colic Arterydependent Colic Graft for Caustic Stricture: Surgical Technique and Postoperative Results

Abstract

INTRODUCTION Stricture formation of oesophagus is inevitable in some cases of caustic ingestion. Oesophageal reconstruction using colon aims to restore both gut continuity and swallowing function. The aim of this retrospective study is to report a 15-year personal experience of surgical management of esophageal caustic stricture by using substernal left colic interposition. MATERIALS AND METHODS From 1999 to 2014, 105 patients with esophageal caustic stenosis were managed surgically. There were 90 women and 15 men. Patients aged from 15 to 70 years. Emergency esophago-gastrectomy was performed in 4 patients. Early gastric stenosis was treated before reconstructive surgery by gastro-jejunostomy in 12 patients. Nutritional disorders were corrected before surgery .The thoracic inlet was enlarged in36 patients. The functional results were evaluated in all patients. RESULTS Postoperative death occurred in 3 patients . The complication rate was 26.6%. The transplant necrosis was occurred in 2 patients .Cervical anastomotic leakage occurred in 15 patients .Early reoperation was performed in 4 patients. Cervical anastomosis stricture occurred in 8 patients. The redundancy was occurred in 2 patients .The swallowing function was considered good in 94 patients ( 89.5%) . Conclusion The early endoscopic evaluation provides accurate diagnosis and permit to define an appropriate therapeutic strategy . The goal of esophageal reconstructive surgery is to restore digestive continuity and good swallowing function .The left colon graft based on left colic vessels and interposed by substernal route is the technique of choice to reconstruct the scarred esophagus with good results. Key words esophageal stricture, left colon graft , results