Colon interposition in the management of post-corrosive strictures

Abstract

: Stricture of the esophagus is the most frequent late sequelae of the ingestion of caustic agents. It is disabling, lead to chronic pain and malnutrition. Endoscopic dilatation still remains the first-line management but cannot be effective in all patients. When surgery is indicated, only selected patients can be submitted to an esophago-gastroplasty. Colon interposition for esophageal replacement is more frequently performed for treatment of caustic burns, but many questions still remain about colonic tract to be used (right or left), route of transposition and timing of the operation. Surgeon’s experience is the most important factor to choose the right colonic tract as esophageal substitute. Age, psychiatric disorders, massive ingestion, emergency tracheotomy, extended visceral resections, short delays in reconstruction, and pharyngeal involvement worsen surgical outcomes, therefore surgery should be performed in high-volume centers. Follow-up of these patients should not tend only to verify the patency of the transit and weight maintenance, but it should identify any lesion of the graft and any metabolic alteration referring to an altered permeability of the transposed colic segment. In this review, we present the main step of preoperative, intraoperative and postoperative pathway of esophageal reconstruction for caustic strictures with a colonic graft, critically exposed according to our experience.