Tu1548 Ligation of Ileocolic Artery Improves the Vascularity of Future Ileocolonic Conduit for Corrosive Injury Esophagus

Abstract

Background: Between June 2005 and January 2010, 47 patients underwent ileocolonic pullup for corrosive esophageal injury with one death. Of these 46 patients surviving 9 (19.5%) had anastomotic leak and 22 (47.8%) developed anastomotic stricture. The cause of these strictures and leak was attributed to ischaemia . Hence we hypothesized that ligation of ileocolic artery (ICA) improves collateral blood supply to the future ileocolonic conduit and in turn decreases the anastomotic leak and stricture rate. Methods: A prospective comparative study was conducted between January 2010 to June 2012. All patients with acute corrosive injuries (grade II and III) who were potential candidates for esophageal replacement surgery and willing to undergo ICA ligation at the time of FJ were included in Group A. During the above period, patients who did not undergo ICA ligation and underwent ileocolonic interposition were taken as control group (Group B). All patients in group A, multislice CECT angiogram was done before ICA ligation, 7 days following ICA ligation and before ileocolonic interposition to document objective improvement in collateral circulation. All patients underwent ileocolonic pull up via retrosternal route after a minimum period of six months following corrosive ingestion. Oral contrast study was done on postoperative day 10 and oral feed was started if there was no leak. All were followed up every 3 weeks for 3 months and every month for another 3 months. Barium swallow was done at 3 weeks to document status of anastomosis. Symptomatic patients with documented anastomotic stricture were subjected for endoscopic dilation. Results: Out of twenty three patients with ileocolonic pull up during the study period, 5 were excluded from the analysis (2 died and 3 did not complete 6 months follow up). Out of the remaining 18 patients considered for evaluation, 6 were in group A and 12 were in group B. Demographic data and level of stricture was not statistically significant in both the groups. Four patients in group B required tracheostomy, none of the patients in group A required tracheostomy. CECT angiogram showed improvement in collateral circulation in all Group A patients. No patient in group A had anastomotic leak and anastamotic stricture, where as in Group B, 3/12 (25%) had anastomotic leak and 4/12 (33.3%) had anastamotic stricture requiring dilatation. Conclusion: Ligation of ileocolic artery improves the vascularity of future ileocolonic conduit and in turn decreases anastomotic leak and stricture rate.