ABSTRACT
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.
ABSTRACT
Objective To investigate the effect of preoperative angiography and intraoperative Doppler blood flow detection in the surgery of colonic interposition for esophageal.Methods Thirty-seven patients who underwent the surgery of colonic interposition for esophageal were chosen,17 cases received colonic interposition for esophageal routine operation (routine group),and 20 cases received preoperative angiography of superior and inferior mesenteric arteries and intraoperative Doppler blood flow detection (improved group),the clinical efficacy was observed.Results Routine group occurred anastomotic leak in 4 cases on postoperative 6-15 d,operation time was (367.0 ± 53.3) min,and improved group occurred anastomotic leak in 1 case on postoperative 7 d,operation time was (302.0 ± 67.1) min,the operation time between two groups had significant difference (P ＜ 0.05).Conclusions The adoption of preoperative angiography and intraoperative Doppler blood flow detection can real-time directly display the vascular morphology of transplanted colon segment,observe the traveling direction and distribution of mesenteric arteries,provide accurate and rehable evaluation of blood vessel of transplanted colon,which can conduct to the optimum selection of transplanted colon and reduce the incidence of postoperative complications.
ABSTRACT
The paper presents the experience of colonic interposition for scar stricture of the esophagus caused by corrosive injures in 30 cases in the past ten years. The caustic agent was lye in 27 cases (90) and acid in 3 cases (10%), in them two patients had severe gastric lesion. All cases were treated by the substernal colonic interposition procedure. The anastomotic sites were in the neck in 26 cases and in the pharynx in 4 cases. In this series transplantations with left part of colon were in 24 cases and right part of colon in 5 cases, and one case was undiscribable. There were 17 postoperative complications (56.7%) and two postoperative deaths. The commonest complication was cervical fistula (7 cases, 23.3%) and the most critical complication was part or complete necrosis (2 cases), one death was directly related to it. The most frequent cause of lye ingestion in Chongqing area and successful repair of anastomotic stenosis with flap of platysma myoides are also discussed in this paper.