technique to improve results in colon replacement of the oesophagus

ABSTRACT

This study aimed to present a simple method to improve the results of colon replacement of the oesophagus in children with post-corrosive oesophageal stricture or long gap oesophageal atresia. At the operation to establish a gastrostomy, the abdomen and colon are explored and the segment of colon to be used for replacement is chosen. The trunk of the middle colic artery supplying the transverse colon is ligated and divided proximal to the marginal artery or if another segment of the colon is chosen, the corresponding vessel is ligated. Between November 1999 and October 2002, 11 children [6 boys and 5 girls] had the middle colic vessels ligated during the gastrostomy operation. Five neonates had long gap oesophageal atresia with or without fistula. The other 6 had long segment oesophageal stricturedue to swallowing caustic potash. Their ages ranged from one day to 40 months. The hospital stay ranged from 10 to 14 days. The interval between vascular ligation and the replacement was one to 3 months depending on the general condition of the patient. The follow up period is 9 to 44 months. The results revealed that after the definitive operation of colon replacement of the oesophagus, the children resumed feeding through the gastrostomy on day 5. They were fed by mouth from day 8 and all were home by day 15. There was no wound infection, no fistula, or chest complications. One patient developed stricture at the colo-oesophageal anastomosis two months after surgery. The oesophageal anastomosis was excised six months after the colon interposition surgery and reanastomosis performed through the same neck incision and the patient was sent home 7 days later. The study concluded that ligation of the middle colic vessels during the gastrostomy operation increases the blood supply to the transverse colon through the left upper colic and marginal vessels. This adds extra ten minutes to the operation of gastrostomy. This technique has increased the success rate in colonic replacement and minimized morbidity in the unit. The principle is commonly used in plastic surgery in pedicled flap reconstruction and in pediatric surgery in high abdominal testis