Aesthetics in Esophageal Reconstruction-Simultaneous Rerouting of the Subcutaneous Colon Segment and Revision of the Neck Scars

Abstract

In the past, esophageal reconstruction was technically difficult and carried high risk of complications. However, most of the problems have been overcome with the advent of modern technologies such as microsurgery. When the esophageal substitute (eg. transposed colon segment) passes via the subcutaneous route, the bulging appearance of anterior chest and abdomen together with the unsightly neck scar can sometimes adversely affect the patient's psychosocial functions. We performed rerouting of the subcutaneous esophagus substitute to substernal route and revision of neck scars simultaneously to improve the cosmetic result. Eleven patients who had undergone subcutaneous transposition of the colon segment due to corrosive esophagitis received the procedures. After psychiatric evaluation, all patients received neck scar revision and rerouting of the colon segment from the subcutaneous route to the substernal route. The substernal route was created with breast dissector without intra-thoracic complications. The procedures were successful in all cases and the mean hospital stay after surgery was 18 days. The esophagogram taken on the 30(superscript th) post-operative day showed smooth passage of the contrast medium in all cases. Simultaneously rerouting of the transposed colon segment and revision of the neck scar is a tedious but safe operation. The procedure not only improves the cosmetic appearance but also enhance the self-esteem and enable the patients to have better psychosocial functions.