Colon Conduit Research Articles

Deloyers Technique for Restoration of Bowel Continuity Following Extended Left Hemicolectomy: A Comprehensive Analysis of 97 Cases and Literature Review.

Deloyers technique addresses challenges in restoring bowel continuity following extended left hemicolectomies. Despite being first described in 1958, the technique remains underutilized, with limited data on long-term outcomes. To evaluate the indications, surgical and functional outcomes of Deloyers technique and review existing literature. Using a prospectively maintained database, patient demographics and perioperative data were collected. A telephone interview was conducted to assess bowel function and statistical analysis identified factors affecting bowel function. Single tertiary care center. Patients that underwent Deloyers technique from January 1995 to February 2023. A total of 97 patients were included. Most common indications were colorectal cancer (50.5%) and diverticular disease (21.6%). In 53.6% of cases DT was performed at re-operations and in 70.1% a diverting loop ileostomy was created. Early surgical complications occurred in 7.2% of patients, including five anastomotic leaks, one colonic conduit ischemia and one small bowel obstruction. Late complications occurred in 8.2%, including 6 anastomotic strictures and 2 chronic leaks. There was no perioperative mortality. A total of 40 patients were interviewed and reported an average of 3.5 bowel movements per day and 0.5 at night, 17.5% used bowel stoppers and 52.5% of patients reported that their bowel function did not impact their quality of life. Previous radiotherapy and anastomosis less than eight cm from the anal verge were associated with having four or more bowel movements per day (p < 0.01). Postoperative morbidity and bowel function. Retrospective analysis of a heterogeneous group of patients with different pathologies and indications for surgery. Deloyers technique is a safe and effective alternative for restoring bowel continuity after extended left hemicolectomy. Postoperative functional results are generally satisfactory, with more favorable outcomes noted in patients with higher anastomoses and those who have not undergone prior pelvic radiotherapy.

333. TECHNICAL CONSIDERATIONS IN UPPER-GI RECONSTRUCTION – A CASE SERIES

Abstract Background Oesophageal reconstruction post-oesophagectomy is performed for both benign and malignant pathologies. Generally, the stomach is the conduit of choice due to its simplicity, requiring only one anastomosis. However, in some cases the stomach may not be a viable option immediately or at all, and alternatives must be considered. We describe a case where the stomach was not immediately viable and two cases where alternative conduits were sought. Furthermore, we discuss techniques such as ‘supercharging’ and ‘superdrainage’ which enhance arterial flow and venous drainage respectively, in order to prevent ischaemia and related complications of the anastomosis site. Methods and Results Case 1 presents a 72-year-old with an incarcerated para-oesophageal hernia leading to necrosis of the distal oesophagus and proximal stomach. After resection, a feeding jejunostomy and a loop oesophagostomy in the neck was created. Months later, the oesophagostomy was closed, and the residual stomach was carefully mobilised into the thorax while preserving the gastro-epiploic arcade, and oesophago-gastric anastomosis was performed. Case 2 involves a 68-year-old female who had elective Nissen fundoplication for a hiatus hernia, which recurred early with strangulation of the distal oesophagus and proximal stomach requiring emergency oesophago-gastrectomy. She later underwent a colonic interposition using the left colon, with superdrainage through an anastomosis between a branch of the middle colic vein to the left external jugular vein. Case 3 describes a 61-year-old male with a gastro-oesophageal adenocarcinoma treated with an Ivor-Lewis oesophagectomy. A year later, he suffered from a strangulated diaphragmatic hernia causing necrosis of the gastric conduit. This was replaced with an isoperistaltic colonic interposition using the transverse and left colon with super drainage. Unfortunately, three years later, this was again complicated with pancreatitis and perforated gall bladder with associated ischaemia of the colonic conduit. A re-do of the colonic interposition using the right colon was done with an arterial graft between the right transverse cervical artery and branch of ileal artery and super drainage via a branch of the ileal and right external jugular veins. Conclusion Primary and in particular secondary re-constructions of the UGI tract are complex procedures and individual approaches are needed as residual anatomy varies. Consequently, such cases require meticulous planning and a multidisciplinary approach involving the cardio-thoracic, plastic and vascular surgeons and adequate support by the anaesthetic and intensive care team. Although associated with significant morbidity and mortality, reestablishment of a swallowing passage is often desired by patients to maintain quality of life.

Surgical replacement of the poorly draining dilated colon conduit urinary diversion in the neurogenic population: A single-center experience of two cases

ABSTRACT Colon is used instead of the typical ileum for urinary conduit diversion in select situations: (1) radiation ileitis, or (2) the “switcheroo” in patients with an existing colostomy or patients undergoing a simultaneous colostomy to avoid a bowel anastomosis. We describe our experience with two patients with spina bifida who underwent a “switcheroo” colon conduit for neurogenic bladder and, later, presented with complications due to distension of their conduit. Neurogenic bowel may lead to urinary stasis in the colon conduit and eventual upper tract complications. Conversion to an ileal conduit resolves these problems; we describe a surgical approach to converting a colon conduit to an ileal conduit.

Multidisciplinary Management of Bladder Agenesis and Anorectal Malformations in Female Patients: A Case Series

Bladder agenesis is an exceedingly rare congenital anomaly with an estimated incidence of 1 in 600,000 [1,2]. Patients born with bladder agenesis carry a poor prognosis due to its association with renal impairment and defects of other organ systems, including the reproductive tract, vascular system, and neurologic system [2-4]. About 90% of those born with bladder agenesis are female, with an estimated female-to-male ratio of 30:1 [1,2]. Herein, we present two cases of bladder agenesis and one case of bladder dysgenesis in female patients; two underwent successful ileal neobladder creation and one underwent incontinent colonic conduit creation.

Laparoscopic extraperitoneal radical cystoprostatectomy: for whom and how?

Background. Laparoscopic radical cystectomy is an established reliable minimally invasive method for the treatment of muscle-invasive bladder cancer. However, in the elderly and patients with serious comorbidities, laparoscopic radical cystectomy is still associated with high risk of complications. There are only a few reports on the use of extraperitoneal access for laparoscopic radical cystectomy in the literature. At the same time, extensive experience has been accumulated in laparoscopic extraperitoneal radical prostatectomy and retroperitoneoscopic operations on the kidney showing significant advantages of extraperitoneal access. Aim. To present initial results of laparoscopic radical cystectomy through extraperitoneal access in medically ill patients.Materials and methods. Between 2017 and 2021, extraperitoneal laparoscopic radical cystectomy was performed at the Volgograd Regional Uronephrology Center in four male patients with tumors affecting the bladder, stages T2–T4. All patients had serious comorbidities. In 3 patients, grade G2–G3 muscle-invasive bladder cancer was histologically verified prior to cystectomy. Two of them had invasion in the posterior urethra. One patient was diagnosed with prostate adenocarcinoma (Gleason score 8 (5 + 3)) with invasion into the bladder wall, ureterohydronephrosis and stage IV chronic kidney disease. None of the patients received neoadjuvant therapy: in 2 cases surgeries were emergency due to recurrent hemorrhages, and 3 patients had significantly decreased kidney function.Results. All operations were performed completely laparoscopically through extraperitoneal access. In 1 case, urine diversion was performed transperitoneally into a colon conduit. Simultaneous retroperitoneoscopic ureterocutaneostomy was performed in two patients: on one side (in a patient with a single functioning kidney) and on both sides, respectively. In a patient with stage V chronic kidney disease and permanent dialysis, bilateral simultaneous retroperitoneal nephrectomies were performed.In 2 patients, salvage cystectomy was done for recurrent bleeding that couldn’t be managed by conservative methods. The maximum intraoperative blood loss did not exceed 500 mL. Bowel function in all patients was recovered within 24–36 hours after the intervention.Conclusion. Laparoscopic extraperitoneal radical cystectomy is a reproducible minimally invasive surgical procedure for bladder cancer treatment that has advantages in terms of postoperative recovery in patients with severe comorbidities. The use of extraperitoneal access may be a rational alternative for salvage cystectomy in male patients. More observations are needed to determine the place of the method in the surgical treatment of muscle invasive bladder cancer.

Resection of anorectal fistula cancer associated with Crohn’s disease after preoperative chemoradiotherapy: a case report

BackgroundAnorectal fistula cancer is often diagnosed in an advanced state, and radical resection is difficult when invasion of the pelvic wall is observed. In addition, there is currently no clear evidence for perioperative treatment of locally advanced cases. We report a case of anorectal fistula cancer with widespread infiltration diagnosed during the course of Crohn’s disease, which was curatively resected after preoperative chemoradiotherapy.Case presentationA 49-year-old man who had been diagnosed with Crohn’s disease (ileocolonic type) at the age of 25 and was found to have an anorectal fistula and perianal abscess at the age of 44 was referred to our department with complaints of abdominal pain and diarrhea. Computed tomography (CT) showed anal stenosis due to a pelvic mass. Pathological analysis of a biopsy taken under general anesthesia indicated mucinous carcinoma. Magnetic resonance imaging (MRI) revealed infiltration into the prostate, seminal vesicles, levator ani muscle, and left internal obturator muscle, and the patient was diagnosed with cT4N0M0 cStage IIIB anorectal fistula cancer (UICC TNM classification 8th edition). After performing a laparoscopic sigmoid colostomy, chemoradiation therapy (capecitabine + oxaliplatin, 50.4 Gy/28fr) was initiated. The patient then underwent laparoscopic total pelvic exenteration, colonic conduit diversion, extensive perineal resection, and reconstruction using bilateral gluteus maximus flaps and a right rectus abdominis musculocutaneous flap. The pathological diagnosis was mucinous adenocarcinoma, pT4, and all margins were negative. No recurrence was evident 6 months after the operation without adjuvant chemotherapy.ConclusionWe described a case of curative resection after preoperative chemoradiotherapy for anorectal fistula cancer with extensive invasion that was diagnosed during the course of Crohn’s disease.An accumulation of cases is needed to determine the usefulness of preoperative chemoradiation therapy for local control of anorectal fistula cancer associated with Crohn’s disease.

Topic: Esophagus Neoplasia (Barrett’s, Cancer) Abstract ID: 20 Surgical and Long-Term Outcomes Following Esophagectomy Using Stomach and Colon Conduits

Topic: Esophagus Neoplasia (Barrett’s, Cancer) Abstract ID: 20 Surgical and Long-Term Outcomes Following Esophagectomy Using Stomach and Colon Conduits

392. PLANNING IS THE KEY—ESOPHAGECTOMY WITH COLONIC INTERPOSITION FOLLOWING: WHIPPLE’S, LEFT LOWER LOBECTOMY, RIGHT PLEURECTOMY AND COLONIC SURGERY

Abstract Link to Video: https://www.dropbox.com/s/wpr3s097g50oadl/Colonic%20interposition%20%28ISDE%20SUBMISSION%29.mp4?dl=0. Description of Video: We report our learnings from a complex surgical case of Ivor Lewis esophagectomy with colonic conduit in a patient who had undergone multiple previous abdominal and thoracic operations. This seventy-two-year-old man was found to have an esophageal adenocarcinoma (T4N0M0) in the distal esophagus with a significant surgical background: Whipple’s procedure for pancreatic cancer; Left lower lobectomy for lung cancer; Right pneumonectomy for recurrent pneumothoraces and a defunctioning stoma for chemotherapy associated anal fistula. To our knowledge, no such case of colonic interposition for esophagectomy has been reported in the literature for a patient with such extensive surgical history. This presented significant surgical and anaesthetic challenges which are explored in the video. Principally the need for extensive planning to anticipate risk and modify procedural steps to account for these accordingly. For example, the operation began with a right thoracotomy, given the possibility that dense adhesions from previous surgery could obstruct safe dissection and subsequently the procedure could be aborted before any critical steps were made. Additionally, we consider the importance of involving other surgical specialities to aid with safe dissection and delineation of anatomy. Each of the key operative steps are described and paired with real-time video footage. Post-operatively we describe how the risk of anastomotic leak given a high-risk anastomosis may be reduced through pre-emptive Endoluminal Vacuum therapy. We also discuss the importance of recognising and managing feculent aspiration pneumonia which is common following this surgery. Discussion of this case and our operative approach would serve to highlight how surgery remains a feasible option for patients despite complex anatomy and surgical history; provided risks are anticipated and appropriately managed.

489. COLON DIVERTICULUM IN THE CERVICAL REGION FOLLOWING COLON INTERPOSITION FOR CORROSIVE INJURY: A CASE REPORT

Abstract Background Colon interposition is one of the traditional procedures for esophageal reconstruction following corrosive injury. While the colonic conduit has the potential to restore swallowing function in patients, yet the long term complications are not well documented. we, herby, present a case of colon diverticulum in the neck 17 years after bypass surgery. Methods a 22 years old female patient presented with a one year history of gradually progressive grade I dysphagia following a colon bypass surgery performed for esophageal reconstruction for corrosive stricture at the age of 5 years old. Clinical assessment revealed the presence of a swelling on the left side of her neck which increased in size upon swallowing. The patient reported that applying pressure on the swelling was associated with sensation of passage of the food bolus. Endoscopic and Radiological assessment confirmed the presence of a neck diverticulum at the site of the anastomosis. Results Neck exploration was performed. The diverticulum was dissected from the surrounding tissues with particular care to preserve the colon mesentery. The esophago-colic anastomosis was identified. It was found that this anastomosis was performed in an end to side fashion. The diverticulum appeared to be the enlarged side of the colon which was enlarged causing compression on the esophagus (1). This part was resected using a stapler after intraoperative endoscopic assessment (2,3). A second layer of interrupted sutures was performed over the stapled part (4). The postoperative course was uneventful and was associated with improved dysphagia. Conclusion Symptomatic colon diverticulum in the neck is a rare long term complication following colon bypass and esophago-colic anastomosis. Particular care should be made when performing it in an end to side fashion. End to end esophago-colic anastomosis could potentially prevent such complication.

Changing trends in the minimally invasive surgery for corrosive esophagogastric stricture.

Esophagogastric stricture is the troublesome long-term complication of corrosive ingestion with a significant adverse impact on the quality of life. Surgery remains the mainstay of therapy in patients where endoscopic treatment is not feasible or fails to dilate the stricture. Conventional surgical management of esophageal stricture is open esophageal bypass using gastric or colon conduit. Colon is the commonly used esophageal substitute, particularly in those with high pharyngoesophageal strictures and in patients with accompanying gastric strictures. Traditionally colon bypass is performed using an open technique that requires a long midline incision from the xiphisternum to the suprapubic area, with adverse cosmetic outcomes and long-term complications like an incisional hernia. As most of the affected patients are in the second or third decade of life minimally invasive approach is an attractive proposition. However, minimally invasive surgery for corrosive esophagogastric stricture is slow to evolve due to the complex nature of the surgical procedure. With advancements in laparoscopic skills and instrumentation, the feasibility and safety of minimally invasive surgery in corrosive esophagogastric stricture have been documented. Initial series have mainly used a laparoscopic-assisted approach, whereas more recent studies have shown the safety of a total laparoscopic approach. The changing trend from laparoscopic assisted procedure to a totally minimally invasive technique for corrosive esophagogastric stricture should be carefully disseminated to preclude adverse long-term outcomes. Also, well-designed trials with long-term follow-ups are required to document the superiority of minimally invasive surgery for corrosive esophagogastric stricture. The present review focuses on the challenges and changing trends in the minimally invasive treatment of corrosive esophagogastric stricture.

The role of intraoperative hyperspectral imaging (HSI) in colon interposition after esophagectomy

BackgroundColon conduit is an alternative approach to reconstructing the alimentary tract after esophagectomy. Hyperspectral imaging (HSI) has been demonstrated to be effective for evaluating the perfusion of gastric conduits, but not colon conduits. This is the first study to describe this new tool addressing image-guided surgery and supporting esophageal surgeons to select the optimal colon segment for the conduit and anastomotic site intraoperatively.Patients and methodsOf 10 patients, eight who underwent reconstruction with a long-segment colon conduit after esophagectomy between 01/05/2018 and 01/04/2022 were included in this study. HSI was recorded at the root and tip of the colon conduit after clamping the middle colic vessels, allowing us to evaluate the perfusion and appropriate part of the colon segment.ResultsAnastomotic leak (AL) was detected in only one (12.5%) of all the enrolled patients (n = 8). None of the patients developed conduit necrosis. Only one patient required re-anastomosis on postoperative day 4. No patient needed conduit removal, esophageal diversion, or stent placement. There was a change in the anastomosis site to proximal in two patients intraoperatively. There was no need to change the side of colon conduit intraoperatively in any patient.ConclusionHSI is a promising and novel intraoperative imaging tool to objectively assess the perfusion of the colon conduit. It helps the surgeon to define the best perfused anastomosis site and the side of colon conduit in this type of operation.

Surgical outcomes and quality of life assessment of esophagectomy for cancer with colon conduit via retrosternal route.

Colon conduit is an alternative to a gastric conduit for esophagectomy in patients that stomach is not available. Surgical technique is complex and has a high risk of morbidities and mortality. Outcomes of patients are still lacking in the literature, thus aims of this study are to evaluate the safety, feasibility and long-term functional outcomes of patients who underwent esophagectomy for cancer with colon conduit via retrosternal route. Twenty-six patients underwent operation between August 2016 and June 2021 for malignancies. Minimally invasive esophagectomy and laparotomy were performed in accordance with the 2017 Japan Esophageal Society's guidelines. Colonic interposition was used for esophageal replacement. Outcomes were technical success, complications assessed using Clavien-Dindo classification, and patient's quality of life (QOL) based on EORTC-QOL-OES18 questionnaire. Mean age was 56.0 ± 9.9years and 21 patients (80.8%) were men. Mean operating time was 432 ± 66min. Technical success was 100%. The average number of resected lymph nodes was 26 ± 14. Twelve patients (46.2%) experienced postoperative complications: 7/12 were classified as grade I-II, 3/12 as grade III, 1/12 as grade IV, and 1/12 as grade V (death). Patient's QOL improved during the follow-up period with median (25-75th percentiles) global EORTC-QOL-OES18 score was 29 (17-34); 13 (9-21), and 9 (6-16) at 3, 6, and 12months, respectively. During the follow-up period, there were 4 late complications, 3 lymphatic recurrences, 5 distant metastases, and 6 deaths. Colon conduit via retrosternal route after esophagectomy is feasible, safe, and could provide acceptable long-term functional outcomes.

Gaining Mesenteric Length following Colorectal Resection: Essential Maneuvers to Avoid Anastomotic Tension.

A surgeon must possess the knowledge and technical skill to obtain length following a left-sided colorectal resection to perform a tension free anastomosis. The distal target organ - either rectum or anus - is fixed in location, and therefore requires surgeons to acquire mastery of proximal mobilization of the colonic conduit. Generally, splenic flexure mobilization (SFM) provides adequate length. Surgeons benefit from clearer understanding of the multiple steps involved in SFM as a result of improved visualization and demonstration of the relevant anatomy - adjacent organs and the attachments, embryologic planes, and mesenteric structures. Much may be attributed to laparoscopic and robotic platforms which provided improved exposure and as a result, development or refinement of novel approaches for SFM with potential advantages. Complete mobilization draws upon the sum or combination of the varied approaches to accomplish the goal. However, in the situation where extended resection is necessary or in the case of re-operative surgery sacrificing either more proximal or distal large intestine often occurs, the transverse colon or even the ascending colon represents the proximal conduit for anastomosis. This challenging situation requires familiarity with special maneuvers to achieve colorectal or coloanal anastomosis using these more proximal conduits. In such instances, operative techniques such as either ileal mesenteric window with retroileal anastomosis or de-rotation of the right colon (Deloyer's procedure) enable the intestinal surgeon to construct such anastomoses and thereby avoid stoma creation or loss of additional large intestine.

207. THE EVOLUTION OF THE PERIOPERATIVE ENHANCED RECOVERY PROTOCOL IN ESOPHAGEAL SURGERY DURING 10 YEARS

Abstract The perioperative enhanced recovery protocol routinely uses in esophageal surgery. It acquired new aspects which were adapted to reduce the rate of morbidity and mortality. Esophagectomy still remains a high-risk operation, which carries out in high-volume centers on patients with significant comorbidities. It challenges the multidisciplinary team to personalize approach to create a safe recovery after surgery. The objective of the study is to show the aspects of evolution of the protocol after esophageal surgery. A total 393 patients with benign and malignant esophageal diseases underwent esophagectomy with simultaneous reconstruction between December 2012 and December 2021. The median age was 59 years (47;67), females were 39,7% and males—60,3%. The prevalence of the patient with nutritional deficiency was 20% (BIM &amp;lt; 18.5) and ASA score III-IV—66,9%. The tranthoracic and transhiatal esophagectomy were used for 42,2% and 57,8% of patients with the reconstruction by gastric pull up (92,1%), colon conduit (6,4%), jejunal loop interpostion with gastric pull-up 1% and with colon conduit 0,5%. 169 patients (43%) had postoperative complications, while 28,9% of them had one complication and 3,6% more than 4 complications at the same time. The prevalence of complications: pneumonia—8,2%, atrial dysrhythmia requiring intervention—7,7%, pulmonary embolism—1%, acute renal failure requiring dialysis—1,5%. The anastomotic leak occured in 5,4% patients and conduit necrosis—in 2,8% (2,3% extensive) patients. The prevalence of patients required repeated surgery was 6,4%. The rate of severe complications (&amp;gt;IIIb- Clavien-Dindo) was 14,4%. Median postoperative day was 9 (8;11). The postoperative mortality rate 1,8%. The aspects of the perioperative enhanced recovery protocol were modified to complicated surgery with simultaneous resection of other organs, esophagogastrectomy or reconstruction by combined conduit with jejunal loop with early oral feeding and rapid recovery. The decade-long experience of the evolution of the perioperative enhanced recovery protocol has led to the development of the personalized approach to the patients with significant comorbidities that allowed reducing the incidence of postoperative complications and mortality after esophagectomy.

591. THE ROLE OF INTRAOPERATIVE HYPERSPECTRAL IMAGING (HSI) IN THE CASE OF USING COLON INTERPOSITION AFTER OESOPHAGECTOMY

Abstract Colon conduit is an alternative option for the reconstruction after oesophagectomy. The impact of using Hypersepctral Imaging (HSI) has been already proved in evaluating the perfusion of gastric conduit, but not in the case of using colon conduit. This is the first study described a new tool evaluating the perfusion of colon conduit and allowing us as esophageal surgeons to choose the appropriate side (left or right) of colon conduit and anastomosis site intraoperatively In 10 patients, who underwent reconstruction with a long segment colon conduit after oesephagectomy from 01.01.2018 till 01.04.2022. HSI was recorded in 8 of these patients at the root and tip of colon conduit after clamping the colic middle vessels allowing us to evaluate the perfusion and the appropriate side of colon conduit (Figure 1) Anastomosis Leakage (AL) grad I° was detected only in one patient (12.5%) of all included patients (n=8). There was no conduit necrosis in all of these patients. Re-anastomosis was necessary only in one patient. There were no need to conduit resection and esophageal diversion or to stent placement in all of included patients. Furthermore, there were no change of the selected side of colon conduit intraoperatively HSI is a promising novel intraoperative imaging tool to evaluate the perfusion of colon conduit objectively, which helping us to make the right decision regarding the side of the colon conduit as well as the site of the anastomosis intraoperatively.

434. A SINGLE INSTITUTIONAL SURGICAL RESULT OF ESOPHAGEAL RECONSTRUCTION WITH SUPERCHARGED JEJUNAL INTERPOSITION FOR PATIENTS WHO LOST BOTH ESOPHAGUS AND STOMACH

Abstract Esophagectomy and gastrectomy are life saving surgeries for severe corrosive injury patients with detergent ingestion. Esophageal reconstruction to restore ingesting ability was performed with colon conduit traditionally. But the sustainability of colon conduit was doubtful. Jejunal graft with supercharged technique is a promising procedure that promise a conduit of smaller diameter and better resistant of lumen distention. The medical records of patient in Chimei Medical Center (CMC) between 2010 to April 2022 were reviewed with keyword of supercharged jejunal graft. The data including patient characteristics, hospital stays, operative technique, and post operative outcomes were collected. Eight patients, 5 female and 3 male, aged 22 to 60 years (median: 45), underwent esophageal reconstruction with supercharged jejunal interposition due to loss of both esophagus and stomach. Seven patients lost esophagus and stomach for detergent ingestion and the rest one has both esophageal and gastric cancer. The following time is between 1 month to 11.5 years (median: 4.4 years). There is no flap loss, no surgical mortality, and all 8 patients still survive to date. All patient could intake solid food. Supercharged jejunal interposition can be safely performed for patient who can’t have gastric tube interposition after esophagectomy. It has good resistance for distention and is an idea substitute of esophagus for young patients who needs a conduit that last lifelong.

657. COMPARISON BETWEEN GASTRIC TUBE AND COLOPLASTY IN ESOPHAGECTOMY AND ESOPHAGEAL BYPASS IN ESOPHAGEAL STENOSIS DUE TO INGESTION CORROSIVE SUBSTANCE

Abstract The treatment of ingestion of caustic agents is controversial in the literature. Surgical therapy has been shown to be the best way to proceed, but the surgical methodology has been varied according to the patient's involvement. This study aims to expose the experience of a single institution in relation to the methodology used for the surgical treatment of esophageal stenosis by ingestion of a caustic substance. A retrospective study was carried out in which data were collected from 27 patients who underwent a surgical procedure for the treatment of esophageal stenosis due to alkali ingestion at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo between 2010 and 2019 and their subsequent comparison between the conduits used in the surgical intervention. Fisher's test was performed to compare the groups regarding cervical leakage and post-surgical symptoms with a significance level of 5%. Of the 27 surgical procedures for esophageal stenosis due to alkali ingestion, 12 performed gastric conduits and 15 colon conduits. When comparing the groups regarding cervical leaks, no statistically significant difference was noted (p = 0.7060). There were also no statistically significant differences regarding the presence of symptoms in the postoperative period (p &amp;gt; 0.99...) Surgical intervention by both gastric and colon conduits showed no differences in cervical leakage and symptom control. Surgical intervention by both gastric and colon conduits showed no differences in cervical leakage and symptom control.

MP25-07 INCIDENCE OF HIGH GRADE COMPLICATIONS AND ASSOCIATED READMISSION RATES FOLLOWING COLON CONDUIT URINARY DIVERSION

You have accessJournal of UrologyCME1 May 2022MP25-07 INCIDENCE OF HIGH GRADE COMPLICATIONS AND ASSOCIATED READMISSION RATES FOLLOWING COLON CONDUIT URINARY DIVERSION Kevin Hebert, Ryan Anderson, Rano Matta, Benjamin McCormick, and Jeremy Myers Kevin HebertKevin Hebert More articles by this author , Ryan AndersonRyan Anderson More articles by this author , Rano MattaRano Matta More articles by this author , Benjamin McCormickBenjamin McCormick More articles by this author , and Jeremy MyersJeremy Myers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002568.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Use of colon for urinary conduit diversion is often performed when there is a lack of viable ileum due to inflammatory small bowel disease, prior small bowel resection, or radiation related changes as a result of prior pelvic radiation. While short and long-term outcomes have been well studied in the ileal conduit population, there is a paucity of evidence assessing complications following colon conduit urinary diversion. Thus, we sought to elucidate the incidence and impact of high-grade complications (Clavien-Dindo IIIa-V) following colon conduit urinary diversion. METHODS: We performed a single institution, retrospective cohort study of patients undergoing colon conduit urinary diversion between April 2011 – January 2021. Perioperative characteristics were assessed including prior radiation, albumin, prealbumin, creatinine, and eGFR. Post-operative 30 and 90-day outcomes were characterized including length of stay, high-grade complication rates, readmission rates, and 90-day procedural/surgery rate. RESULTS: We identified 36 patients, median age 60 years [IQR 52,70] who underwent colon conduit urinary diversion during our study period. Colon segments utilized included transverse colon (63.8%), colon switch (19.4%), and sigmoid colon (16.7%). Active tobacco use at the time of surgery occurred in 14.8% of patients. Prior radiotherapy was common with 76.5% and 22.2% reporting prior history of external beam radiation and brachytherapy, respectively. Preoperative characteristics, median [IQR], included: body mass index 26.5 [22.9, 30.8], albumin 3.70 [3.2, 3.9], prealbumin 21.8 [17.6, 32.9], creatinine 0.9 [0.73, 1.20], and eGFR 83 [53, 101]. Median length of stay was 11 days [8, 15]. 30 and 90-day high grade complications were common, occurring in 33.3% and 52.7% of patients, respectively. Within 30-days of surgery, 27.8% of patients required readmission, which increased to 61.1% by 90 days after surgery. More than 1 readmission within 90 days of surgery occurred in 19.5%, while the incidence of a secondary procedure/surgery occurring over the same time period was 33.3%. CONCLUSIONS: In a cohort with a high prevalence of prior pelvic radiation therapy, the risk of high-grade complication, readmission within 90 days of surgery, and secondary procedure/surgery following colon conduit urinary diversion was high. The addition of multi-institutional data is necessary to better characterize the post-operative risks associated with colon conduit diversion in this patient population. Source of Funding: NA © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e430 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Hebert More articles by this author Ryan Anderson More articles by this author Rano Matta More articles by this author Benjamin McCormick More articles by this author Jeremy Myers More articles by this author Expand All Advertisement PDF DownloadLoading ...

Indocyanine Green Near Infrared Fluorescence Imaging for Colonic Conduit Perfusion Assessment in Colon Pull-up for Corrosive Oesophageal Strictures

Indocyanine Green Near Infrared Fluorescence Imaging for Colonic Conduit Perfusion Assessment in Colon Pull-up for Corrosive Oesophageal Strictures

Nonsupercharged Retrosternal Roux-en-Y Esophagojejunostomy for Distal Esophageal Reconstruction

BackgroundDelayed distal esophageal reconstruction with nonsupercharged jejunum is an option when gastric conduit is not available. This study aimed to describe a single-center experience with distal esophageal reconstruction with retrosternal Roux-en-Y esophagojejunostomy (RYEJ) and compare perioperative outcomes with retrosternal gastric pull-up (GP). MethodsAn Institutional Review Board–exempt retrospective chart review was conducted of patients who underwent esophagostomy closure by the retrosternal route at the University of Minnesota Medical Center (Minneapolis, MN) from January 2009 to July 2019. Patients with colonic conduits were excluded. The study compared patients with RYEJ with a contemporary cohort of patients who underwent GP. The anatomic criteria for RYEJ were the absence of a gastric conduit and an esophageal remnant that reached the sternomanubrial joint. Patient characteristics, anastomotic leak and stricture rate, postoperative complications, hospital length of stay, 30-day readmission, and 90-day mortality were recorded. Statistical analysis was performed using the Fisher exact test and the Wilcoxon rank-sum test with a significance level at P ≤.05. ResultsA total of 9 patients underwent RYEJ, and 10 patients had GP. Previous esophageal adenocarcinoma was more common in the RYEJ group (n = 5) compared with the GP group (n = 0) (P = .01). Patient demographics and comorbidities were comparable between the groups. No differences were found in all end points, including operating time, estimated blood loss, anastomotic leak or stricture rate, Clavien-Dindo class III to IV complications, hospital length of stay, or mortality. ConclusionsRetrosternal RYEJ without microvascular augmentation is a safe alternative for esophagostomy closure in patients with adequate esophageal length when the stomach is not available. The nonsupercharged jejunum can safely reach the level of the sternomanubrial joint.