Colonic Graft Research Articles

The presence of adenocarcinoma of the right colon and polyp in colonic graft in a female patient with colon interposition due to caustic stricture of the esophagus in childhood

Introduction. Colon interposition is considered an effective option for esophageal replacement in children, particularly in cases of caustic esophageal stricture. The use of colonic tissue grafts for esophageal replacement can lead to late complications, including the development of precancerous lesions and malignant tumors. The aim of the paper is to describe a female patient who was diagnosed with adenocarcinoma of the right colon at the age of 71, 60 years after surgery for benign esophageal stricture. Case outline. A 71-year-old female presented to our clinic in January 2023 with symptoms of abdominal pain. At the age of 11, the patient had bypass esophagocoloplasty with retrosternal esophagogastrocolonic anastomosis due to esophageal stricture after accidental caustic ingestion. CT imaging revealed tumor of the ascending colon, estimated stage T4aN1M0. An upper digestive endoscopic examination revealed one polyp while a lower digestive endoscopic examination confirmed the presence of a stenotic tumor in the ascending colon. Furthermore, a polypoid alteration was identified in the descending colon. CT angiography revealed that the tumor was found to receive its vascular supply through the middle colic artery, while the colonic transplant received its vascular supply through the right colic artery. Conclusion. It is recommended to implement lifelong endoscopic surveillance for patients who have undergone colon interposition. In cases such as this, it is crucial to establish a comprehensive treatment plan and employ effective diagnostic measures to ensure the preservation of the integrity and vascularization of the colonic graft.

Colon interposition in the management of post-corrosive strictures

: 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.

Colon patch esophagoplasty for esophageal strictures refractory to multi-modal treatment revisited.

Esophageal strictures due to caustic ingestion (CI) may require repeat esophageal dilations and dilation adjuvants, including local anti-fibrinogenic injection therapy, stent placement, and radial stricture incisions. Refractory strictures require surgical intervention. Pedicled colon patch esophagoplasty (CPE) may avoid the morbidity associated with total esophageal replacement, although reports of its use are limited. Indications and outcomes for CPE in patients undergoing repeat esophageal stricture dilations following caustic ingestion are described according to our local experience and literature reports. A retrospective review of indications for surgical management of esophageal strictures to tertiary pediatric surgical services between 2015 and 2020 focused on patients undergoing CPE. English-language literature (PubMed, Google Scholar, and Scopus) describing CPE was also reviewed. Eight (12%) out of 65 patients with esophageal strictures requiring 7 or more esophageal dilations with poor response underwent surgical stricture management over a 6year period, which included stricture resection and re-anastomosis in 2 patients, total esophageal replacement with colon graft in 2 patients, gastric pull-up in 1 patient, and CPE in 3 patients. The patients undergoing CPE were aged 3-8years and had 17 to more than 25 dilations following caustic ingestion over a 2-5year period. One patient had a 4cm stricture; the other 2 had strictures 7cm in length. A transverse colon patch based on the middle and left colic vessels was utilized in all three, with the vascular pedicle placed retrogastrically via the esophageal hiatus and the patch inlay esophagoplasty concluded via right thoracotomy. Post-operative contrast studies showed near-normal anatomy, and the patients could tolerate full oral diets. During a 9-36month follow-up period, only 2 patients required dilations of a proximal anastomotic stricture at 1 and 5months postoperatively. One patient required additional proximal stricturoplasty with advancement of the original graft across the stricture via a cervical surgical approach. Colon patch esophagoplasty to restore esophageal luminal continuity and allow a normal diet should be considered for refractory esophageal strictures. CPE had excellent functional outcomes in our 3 patients and should be considered in selected cases instead of total esophageal replacement.

S369 Dysphagia From an Ischemic Colonic Segment in a Patient With Colon Interposition

Introduction: Colon interposition of the esophagus in adults may lead to future complications including chronic ischemia, stricture formation, and adenocarcinoma. Case Description/Methods: A 39-year-old male immigrant presented with progressive dysphagia, in the setting of a remote history of emergent colon interposition following gunshot wounds of the esophagus. In the prior 6 months, he developed dysphagia with solids and then liquids, with associated weight loss and regurgitation. On admission, he had stable vitals with an unremarkable physical exam and labs. Esophagram revealed a severe high-grade, upper-mid esophageal stricture with proximal dilation (Figure 1A). Computed Tomography (CT) imaging showed an esophageal conduit in the anterior mediastinum with proximal conduit distension and distal conduit narrowing (Figure 1B). Esophagoduodenoscopy (EGD) revealed a stricture (6 mm) at the esophago-colonic anastomosis, 19 cm from the incisors (Figure 1C). This was traversed with an ultra-thin endoscope which also revealed a severe stenosis distally in the colon segment with a partially obstructing inflammatory polyp. The proximal stricture was dilated in a staged fashion to advance the upper endoscope to the colonic stenosis. A wire was advanced and the stenosis length was estimated to be 11 cm under fluoroscopy. This was successfully stented with 20 mm x 12 cm covered metal stent. The stent was removed one month following the procedure with initial improvement in dysphagia and a normalized diet. However, the patient had re-occurring symptoms and a repeat EGD with dilation and stenting was performed one week later. The multidisciplinary team recommended definitive treatment for the chronic ischemic segment-related complications. Discussion: Conduit ischemia with anastomotic strictures can occur in patients with a history of colonic interposition. Evaluation with double contrast studies may reveal ischemic changes including loss of haustration and stricture formation in the colon graft with dilation being an effective treatment. Chronic ischemia can be a delayed complication of the interposed colon resulting from non-necrotic vascular insufficiency leading to fibrosis, stricture formation, and dysphagia. Additionally, given the patient’s stricture and mass, there was concern for underlying malignancy, which highlights the utility of adenocarcinoma screening in this patient population. Watch the video at https://tinyurl.com/ACGAbstractS369Figure 1.: 1A: Esophagram showing severe high-grade stricture at the junction of the cranial one third and distal two thirds of the esophagus. 1B: CT chest showing conduit extending along anterior mediastinum and deep into the sternum with anastomosis in upper neck and abrupt caliber change in mid esophageal conduit at level of right main pulmonary artery with associated wall thickening, fat stranding, and small adjacent lymph nodes measuring up to 5mm (red arrow). 1C: Esophago-colonic anastomosis found in the middle/lower third of the esophagus at 29cm from incisors.

Nutritional benefit of remnant gastric preservation in patients with esophageal cancer undergoing radical esophagectomy and ileo-colon interposition

BackgroundThis retrospective study aimed to investigate the short-term surgical outcomes and nutritional status of ileo-colon interposition in patients with esophageal cancer who could not undergo gastric tube reconstruction.MethodsSixty-four patients underwent subtotal esophagectomy with reconstruction using ileo-colon interposition for esophageal cancer at the Wakayama Medical University Hospital between January 2001 and July 2020. Using propensity scores to strictly balance the significant variables, we compared treatment outcomes.ResultsBefore matching, 18 patients had cologastrostomy and 46 patients had colojejunostomy. After matching, we enrolled 34 patients (n = 17 in cologastrostomy group, n = 17 in colojejunostomy group). Median operation time in the cologastrostomy group was significantly shorter than that in the colojejunostomy group (499 min vs. 586 min; P = 0.013). Perforation of the colon graft was observed in three patients (7%) and colon graft necrosis was observed in one patient (2%) in the gastrojejunostomy group. Median body weight change 1 year after surgery in the cologastrostomy group was significantly less than that of the colojejunostomy group (92.9% vs. 88.5%; P = 0.038). Further, median serum total protein level 1 year after surgery in the cologastrostomy group was significantly higher than that of the colojejunostomy group (7.0 g/dL vs. 6.6 g/dL, P = 0.030).ConclusionsSubtotal esophagectomy with reconstruction using ileo-colon interposition is a safe and feasible procedure for the patients with esophageal cancer in whom gastric tubes cannot be used. Cologastrostomy with preservation of the remnant stomach had benefits in the surgical outcomes and the postoperative nutritional status.

A Good Result of Cardiopulmonary Resuscitation Following Colonic Segment Interposition with Vascular Supercharge

A 70-year-old man who underwent surgical excision of an esophageal leiomyoma developed esophageal leak and underwent esophagectomy. Colonic segment interposition was performed to address the esophageal defect. Cardiopulmonary resuscitation (CPR) was subsequently performed for desaturation due to pulmonary atelectasis; spontaneous circulation resumed without indication of contrast leakage or necrosis. Redundancy of the esophagus in the neck occurred due to migration of the colon segment during CPR. We shortened the colonic segment, which improved swallowing function. Here we report the first case of a positive outcome of cervical herniation of a colon graft due to CPR after a colonic interposition procedure.

96: EXPERIENCE IN RECONSTRUCTION OF LARYNGOPHARYNGOESOPHAGECTOMIES IN A THIRD LEVEL CENTER

Abstract Background and aim Pharyngoesophageal reconstruction after laryngo-pharyngo-esophagectomy is challenging due to its high morbidity and mortality. There are different reconstructive flaps: visceral flaps (pedicle stomach and colon flaps and free jejunum or colon grafts) and myocutaneous flaps (pedicle local flaps or free grafts). The objective is to evaluate the morbidity and mortality and functional results of the reconstruction after laryngo-pharyngo-esophagectomy. Methods This is a retrospective study of patients who underwent laryngo-pharyngo-esophagectomy in our center, due to a benign cause (caustic ingestion) or malignant (larynx, pharynx, parathyroid and cervical esophagus cancer) with circumferential pharyngeal reconstruction with flap, from 2008 to 2020. Demographic variables, procedure performed and flap used for reconstruction, complications related to reconstruction (fistula, stenosis, necrosis), postoperative complications, days until adequate swallowing, flap’s functional result, hospital stay, recurrence and mortality were collected. Results Twelve patients, with 59 years (45–78) median age, underwent surgery. There were complications related to reconstruction in 42% of the patients (Table 1). Postoperative morbidity was 67%. The median hospital stay was 21 days (16–94). The median time to swallowing was 13 days (3–73). An optimal functional result (oral intake) was achieved in 75%. The median follow-up was 18 months (4–56), with a survival rate of 50%. 30-days mortality was 8%. Conclusion Our study shows a high morbidity and mortality after circumferential pharyngeal reconstruction, similar to literature published. We have observed a higher rate of reconstruction related complications and worse functional results in reconstructions performed with gastroplasty and coloplasty after total laryngo-pharyngo-esophagectomy, compared to less aggressive local resections with ALT free flap reconstruction. Table https://secure.sem-2000.it/semUpload/OLC/file/9203828791100911681076702/93727_Table.jpg.

746 EXPERIENCE IN RECONSTRUCTION OF LARYNGOPHARYNGOESOPHAGECTOMIES IN A THIRD LEVEL CENTER

Abstract Pharyngoesophageal reconstruction after laryngo-pharyngo-esophagectomy, due to malignant or benign causes, is challenging due to its high morbidity and mortality. There are different reconstructive flaps: visceral flaps (pedicle stomach and colon flaps and free jejunum or colon grafts) and myocutaneous flaps (pedicle local flaps, such as the pectoralis major flap, or free grafts, such as the anterolateral thigh-ALT). The objective is to evaluate the morbidity and mortality and functional results of the reconstruction after laryngo-pharyngo-esophagectomy. Methods This is a retrospective study of patients who underwent laryngo-pharyngo-esophagectomy in our center, due to a benign cause (ingestion of caustic) or malignant (cancer of the larynx, pharynx, parathyroid and cervical esophagus) with circumferential pharyngeal reconstruction with flap, from 2008 to November 2020. Demographic variables, neoadjuvant treatment, procedure performed and flap used for reconstruction, complications related to reconstruction (fistula, stenosis, necrosis), postoperative complications, days until adequate swallowing, functional result of the flap, hospital stay, recurrence and mortality were collected. Results Twelve patients, with a median age of 59 years (45–78), underwent surgery, 1 case due to benign cause and 11 cases with an oncological diagnosis. There were complications related to the reconstruction in 42% of the patients (see table 1). Postoperative morbidity was 67% (75% Clavien-Dindo ≥ III). The median hospital stay was 21 days (16–94). The median time to swallowing was 13 days (3–73). An optimal functional result (oral intake) was achieved in 75% (only 3 patients with poor results). The median follow-up was 18 months (4–56), with a survival rate of 50%. 30-days mortality was 8% (1 case). Conclusion Our study shows a high morbidity and mortality after circumferential pharyngeal reconstruction, similar to literature published. We have observed a higher rate of reconstruction related complications (fistulas and stenosis) and worse functional results in reconstructions performed with gastroplasty and coloplasty after total laryngo-pharyngo-esophagectomy, compared to less aggressive local resections (laryngopharyngeal) with ALT free flap reconstruction.

490 COLONIC INTERPOSITION FOR ESOPHAGEAL REPLACEMENT AFTER ESOPHAGECTOMY FOR CANCER—A SINGLE CENTER EXPERIENCE

Abstract The standard esophageal replacement after esophagectomy for cancer treatment is a gastric conduit, as it is a simpler technique than the other options available, requiring only one anastomosis. However, when the stomach is not available, a left- or right colon graft interposition can be performed. The purpose of this study was to review our experience with colon interposition following esophagectomy for cancer and assess the surgical outcomes. Methods The clinical data and surgical outcomes form patients who underwent esophagectomy with colon interposition for cancer treatment, in a single institution, between January 1990 and December 2017. The results were compared with cases with gastric reconstruction. Results From January 1990 and December 2017, 25 cases of transhiatal esophagectomy with colon interposition were identified. In the same period, 97 cases of transhiatal esophagectomy with gastric pull-up were also performed. The patient’s clinical data and surgical outcomes are presented in Table 1. The indication for performing a colon interposition was positive distal margin in 87% of cases, gastric conduit ischemia in 8,7% and prior gastric surgery in 4,3%. The most common pull-up route was the posterior mediastinum (87%). Conclusion Our results are in line with the literature and demonstrate that colon interposition after esophagectomy is feasible and, despite having a significant morbimortality, appears to be a valuable alternative for the challenging situation where the stomach is not available.

Ileo-right colonic reconstruction preserving all four colonic vessels after esophagectomy for cancer.

When colonic graft is used as an esophageal substitute after esophagectomy, one or two feeding vessels of the colon are cut to obtain sufficient length, the graft is passed via the subcutaneous route, and microvascular anastomosis is often used to avoid fatal complications. Sixteen consecutive ileo-right colonic reconstructions via the posterior mediastinal or retrosternal route with preservation of all four colonic vessels were performed in the past eight years. We presented the surgical technique and evaluation of this surgical method. In 15 out of 16 consecutive cases, the graft could be pulled up to the neck through the posterior mediastinal or retrosternal route while preserving all four colonic vessels. Reconstruction was not possible in one patient because of ileocolic vessel injury during colonic mobilization. Anastomotic leakage occurred in three patients, but all were minor and were treated conservatively. There were no patients with graft necrosis resulting from insufficient blood supply. Ileo-right colonic reconstruction with preservation of all four colonic vessels through the posterior mediastinal or retrosternal route is a safe and feasible procedure and is considered the first choice for colonic reconstruction as an esophageal substitute.

In Vivo Colon Regeneration: from Decellularization to In Vivo Implantation in a Rat Model Using the Body as a Natural Bioreactor

Production of a tissue-engineered scaffold for replacement of colon would be a breakthrough affecting the clinical approach to several conditions, and it would alter the fate of patients who need total colectomy with ileoanal anastomosis. In the current study, we aimed to determine the histological aspects of a decellularized colon graft for further colon recellularization using omentum as a natural bioreactor in healthy rats. Colon tissues were decellularized by a 24-h detergent perfusion procedure. The scaffolds were examined by several investigations to verify the efficacy of the decellularization procedure. For recellularization, scaffolds were implanted in omental wraps and biopsies were taken from implanted scaffolds 2 and 4 months post-operatively to examine the extent of cell infiltration and cellular differentiation of regenerated tissues. Implanted scaffolds of 2 months were not completely recellularized and were mostly populated by undifferentiated cells and some inflammatory cells. Immunohistochemical evaluation of the implanted scaffolds after 4 months demonstrated sufficient cellularity and appropriate cell differentiation into epithelial and muscular cells, as well as similar structure to the normal colon. The present study displays the efficiency of omentum as a natural bioreactor for recellularization of decellularized colon scaffolds. Previously, we evaluated the histological aspects of a decellularized colon scaffold for bladder augmentation in rat model. In this study, we try to assess the efficacy of a perfusion-based decellularization protocol of colon organ for further colon tissue engineering. We also aim to evaluate the effectiveness of omentum as a natural bioreactor for recellularization of decellularized colon scaffolds.

Imre József a magyar nyelőcsősebészet megalapitója

József Imre as a member of Surgical Clinic personnel of Szeged University spent several months at the surgical department of the world-known R. Belsey in Leeds in the 6th decade of the last century. After returning home he introduced such operations in the domestic surgical practice as the Belsey-Mark IV antireflux fundoplication, fundoplication combined with myotomy, diverticulectomy + myotomy in Zenker diverticula, the Belsey type long left colonic graft for replacement of esophageal corrosive strictures and the monofil suture of oesophagal anastomosis. He prepared Tygon prosthesis for palliative oesophagal intubation. J. Imre was the author of the oesophagus chapter in Imre Littman’s monography of surgery. A large number of oesophagus operations was performed in his professional life. He left a total body of work behind. Cut in stone, his exceptional personality is commemorated in the pantheon of Surgical Clinic at Szeged University.

The impact of fatal complications
 on surgical esophagocoloplasty outcome
 in cancer patients

Relevance: The impact of esophageal cancer surgery complications on survival rate remains a challenge due to the complications and mortality associated with surgical esophagocoloplasty.
 The purpose of this study was to assess the impact of fatal complications (colonic graft necrosis and pneumonia) on surgical esophagocoloplasty outcomes in cancer patients.
 Results: The analysis included 110 patients treated by colonic esophagoplasty for esophageal carcinomas and gastroesophageal junction carcinomas. The frequency of postoperative complications of degree III-IV according to Clavien-Dindo was 36.4%
 (40/110). Pneumonia developed in 15% (16/110), colonic graft necrosis – in 5% (6/110). Out of all causes of death (pneumonia, graft necrosis, bleeding, pulmonary thromboembolism), only graft necrosis (odds ratio (OR) 21.112 [95% CI 2.751-162.013]
 p=0.003) and pneumonia (OR 15.141 [95% CI 3.225-71.089] p=0.001) were the predictors for 90-days’ mortality. Mortality from
 pneumonia amounted to 37.5% (6/16), from necrosis – 50% (3/6). Median overall survival without pneumonia (n=94) and with
 pneumonia (n=16) was 26.6 and 8.0 months, respectively (plogrank=0.030; pcox=0.034). Median overall survival without graft necrosis (n=104) and with necrosis (n=6) was 26.6 and 3.7 months, respectively (plogrank=0.0001; pcox=0.001). The patients subjected to
 colonic esophagoplasty with planning (n=55) had fewer postoperative complications (56.4% [31/55] vs. 16.4% [9/55], p<0.0001),
 lower risk of their development (OR 0.151, 95% CI 0.0620.369, p<0.0001), higher overall 10-year survival (26.0% vs. 17.7%) and
 median survival (49.8 vs. 17.4 months, plogrank=0.038, pcox=0.041).
 Conclusions: Postoperative development of pneumonia or colonic graft necrosis is associated with a significant deterioration in treatment outcomes. Improving the surgical management of cancer patients who require esophagocoloplasty
 has the potential to improve long-term survival.

Sigmoid vaginoplasty in Mayer-Rokitansky-Kuster-Hauser syndrome

IntroductionMayer-Rokitansky-Kuster-Hauser syndrome (MRKH) is characterized by congenital aplasia of the uterus and upper 2/3 of the vagina, with normal female secondary sexual characteristics and a normal karyotype (46, XX). The frequency is 1/4500–5000 female births. The aim of this study was to report the management of MRKH syndrome with sigmoid vaginoplasty.Patients and methodThis study included 4 patients recruited over a 4-year period from February 2016 to January 2019. MRKH syndrome was retained in the presence of normal secondary sexual characteristics with normal external genitalia associated with vaginal aplasia and uterine agenesis. The approach was a laparotomy and a perineal approach under general anesthesia. The procedure involved the removal of a sigmoidal colonic graft that was anastomosed with the vaginal dimple.ResultsThe average age was 23 years. All patients had consulted for primary amenorrhea, infertility, and/or difficulties in sexual intercourse. The diagnosis of MRKH type 1 was retained in all patients. The average length of the vagina was 3.25 cm before surgery and 13.63 cm after surgery. The postoperative outcomes were uneventful in 3 patients. One patient developed anastomotic stenosis that was successfully treated with vaginal dilation for 2 weeks. The average postoperative follow-up was 30 months.ConclusionIn the context of a low-resource setting, sigmoid transposition represents a good procedure to treat vaginal aplasia and restore a satisfactory sexual activity to patients with MRKH type 1.

In vivo application of decellularized rat colon and evaluation of the engineered scaffolds following 9 months of follow-up.

The aim of this study was to investigate the rat small intestine mesentery and colon as natural bio-reactors for rat colon-derived scaffolds. We decellularized eight whole rat colons by a perfusion-based protocol using 0.1% sodium dodecyl sulfate for 24 hr. The provided bio-scaffolds were examined by histological staining, scanning electron microscopy, and collagen and sulfated glycosaminoglycan quantification. Subsequently, we implanted 4 cm segments of the provided bio-scaffolds into two groups of animal models comprising tissue grafting into the mesenteric tissue (n: 10) and end-to-end anastomosis (n: 10) to the colon of host rats. Following 9 months of follow-up, we harvested the grafts and performed histological and immunohistochemical studies as well as real-time PCR evaluation for telomerase activity of the samples. Histological staining, scanning electron microscopy and protein content evaluation of the acellular tissues confirmed the complete removal of the cellular components and preservation of the extracellular matrix. Histopathological assessment of the implanted scaffolds was suggestive of a regenerative process in both groups. Moreover, immunohistochemical analysis of the samples confirmed the presence of smooth muscle cells, endothelial progenitor cells, and neural elements in both groups of grafted scaffolds. Our data confirmed the recellularization of the acellular colon grafts in both groups after 9 months of follow up. Also, the implanted tissues demonstrated different characteristics based on their implantation location. The outcomes of this investigation illustrate the capability of acellular tissues for in vivo application and regeneration.

Iso-peristaltic colonic loop interposition for the treatment of benign oesophageal stricture: a case report with review of literature

Corrosive oesophageal strictures are a common and debilitating condition in India. Patients generally have dysphagia, cachexia, drooling of saliva, aspiration pneumonitis, and lung abscess. Though endoscopic dilatations are done in cases of short segment strictures, surgical oesophageal by pass is the permanent solution for this condition. A 24 years female presented with complaints of dysphagia and cachexia, due to corrosive stricture. Patient had a history of poison ingestion 2 years back. Intra-operatively stricturous mucosa is excised and an iso peristaltic colonic loop by pass was carried out. Post operatively patient had a complication of anastomotic leak which was treated conservatively, excepting which patient is symptom free and gaining weight on a follow up period of 1 year. Ever since first described by Kelling and Vuillet in 1911 colonic interposition is mostly used around the globe for oesophageal bypass in both benign and malignant conditions. Stomach and jejunum are the other conduits that can be used. Iso peristaltic loop is mostly used to reduce the incidence of reflux. Right colon or transverse colon graft based on the mid colic artery or the left colic artery owing to the reliable blood supply and less diameter. This procedure has a high complication rate of around 27% most of which are due to the vascular comprise of the graft.

The neovaginal microbiome of transgender women post-gender reassignment surgery

BackgroundGender reassignment surgery is a procedure some transgender women (TW) undergo for gender-affirming purposes. This often includes the construction of a neovagina using existing penile and scrotal tissue and/or a sigmoid colon graft. There are limited data regarding the composition and function of the neovaginal microbiome representing a major gap in knowledge in neovaginal health.ResultsMetaproteomics was performed on secretions collected from the neovaginas (n = 5) and rectums (n = 7) of TW surgically reassigned via penile inversion/scrotal graft with (n = 1) or without (n = 4) a sigmoid colon graft extension and compared with secretions from cis vaginas (n = 32). We identified 541 unique bacterial proteins from 38 taxa. The most abundant taxa in the neovaginas were Porphyromonas (30.2%), Peptostreptococcus (9.2%), Prevotella (9.0%), Mobiluncus (8.0%), and Jonquetella (7.2%), while cis vaginas were primarily Lactobacillus and Gardnerella. Rectal samples were mainly composed of Prevotella and Roseburia. Neovaginas (median Shannon’s H index = 1.33) had higher alpha diversity compared to cis vaginas (Shannon’s H = 0.35) (p = 7.2E−3, Mann-Whitney U test) and were more similar to the non-Lactobacillus dominant/polymicrobial cis vaginas based on beta diversity (perMANOVA, p = 0.001, r2 = 0.342). In comparison to cis vaginas, toll-like receptor response, amino acid, and short-chain fatty acid metabolic pathways were increased (p < 0.01), while keratinization and cornification proteins were decreased (p < 0.001) in the neovaginal proteome.ConclusionsPenile skin-lined neovaginas have diverse, polymicrobial communities that show similarities in composition to uncircumcised penises and host responses to cis vaginas with bacterial vaginosis (BV) including increased immune activation pathways and decreased epithelial barrier function. Developing a better understanding of microbiome-associated inflammation in the neovaginal environment will be important for improving our knowledge of neovaginal health.A1pw-5DXJFMq35mSKHH2fxVideo

Beyond 10years, with or without an intestinal graft: Present and future?

Long-term outcomes in children undergoing intestinal transplantation remain unclear. Seventy-one children underwent intestinal transplantation in our center from 1989 to 2007. We report on 10-year posttransplant outcomes with (group 1, n=26) and without (group 2, n=9) a functional graft. Ten-year patient and graft survival rates were 53% and 36%, respectively. Most patients were studying or working, one third having psychiatric disorders. All patients in group 1 were weaned off parenteral nutrition with mostly normal physical growth and subnormal energy absorption. Graft histology from 15 late biopsies showed minimal abnormality. However, micronutrient deficiencies and fat malabsorption were frequent; biliary complications occurred in 4 patients among the 17 who underwent liver transplantation; median renal clearance was 87mL/min/1.73m2 . Four patients in group 1 experienced late acute rejection. Among the 9 patients in group 2, 4 died after 10years and 2 developed significant liver fibrosis. Liver transplantation and the use of a 3-drug regimen including sirolimus or mycophenolate mofetil were associated with improved graft survival. Therefore, intestinal transplantation may enable a satisfactory digestive function in the long term. The prognosis of graft removal without retransplantation is better than expected. Regular monitoring of micronutrients, early psychological assessment, and use of sirolimus are recommended.

Reoperative surgery for colon conduit failure: a major challenge in esophageal reconstruction

Colon interposition is a second-line reconstructive option after esophagectomy for carcinoma, caustic or peptic lesions refractory to dilatation, perforation or trauma, and end-stage achalasia (1); in other instances, such as prior gastrectomy, necessity of concomitant gastrectomy for syncronous gastric tumors, extensive gastric damage from caustic ingestion, proximal squamous-cell carcinoma, or failures of previous gastric pull-up, the stomach may not be available as a first-choice conduit or an extra-long graft may be required to reach the hypopharynx (2). The most typical colon transplant is a long graft with an upper intrathoracic or neck anastomosis, and location of the anastomosis depends on the route of colon interposition. A retrosternal route and a cervical esophago-colic anastomosis is generally preferred in patients with “hostile” mediastinum from previous thoracotomy or radiotherapy, or as a second-stage “bypass” procedure following emergency esophagectomy or esophageal exclusion and diversion (3). Rarely, when the retrosternal route is not viable due to previous sternotomy, the colonic graft can primarily be placed antesternally through a subcutaneous tunnel.

PROSPECTIVE AND RETROSPECTIVE STUDY OF COLONIC INTERPOSITION IN BENIGN AND MALIGNANT ESOPHAGEAL LESION.

The Retrospective and prospective study entitled "Prospective and Retrospective study of Colonic Interposition in Benign and Malignant Esophageal Lesion" will be conducted in the Department of Surgery of MGM Medical College and M.Y. Hospital, Indore over a period of 2 year.&#x0D; The above table shows the distribution of patients according to presenting complains. 1 (3.3%) patient presented with liquid dysphagia, 23 (76.7%) patients presented with solid and liquid dysphagia and 6 (20.0%) patients presented with solid dysphagia. Majority of the patients had solid and liquid dysphagia. the distribution of patients according to diagnosis. 6 (20.0%) patients had carcinoma esophagus and 24 (80.0%) patients had esophageal strictures. Majority of the patients had esophageal strictures. Comparison of wound site infection. At 2 weeks, 2 (6.7%) patients had wound site infection, which was still present at 1 month and decreased to 1 (3.3%) at 3 months. After 3 months, none of the patients had wound site infection.&#x0D; The colon interposition is an alternative option for esophageal reconstruction when the stomach is unavailable the quality of life after colonic transposition compared at postoperative 1 month and 2 year using specially designed QOL questionnaire for coloplasty patients. Our disease specific questionnaire performs well in relation to previously published study which was used same questionnaire asses the quality of life. in post coloplasty patients According to the selected colon graft (left or Right) route of reconstruction, direction of graft various surgical procedures can be considered for colonic reconstruction in present study left colic artery based left colonic graft is used. Regardless of the situation, blood supply of colon graft directly affect the outcome of the surgery.&#x0D; Keywords: Colonic, Interposition, Esophageal &amp; Lesion.