Late Morbidity After Colon Interposition for Corrosive Esophageal Injury
- 1 August 2010
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 252 (2), 271-280
- https://doi.org/10.1097/sla.0b013e3181e8fd40
Abstract
The aim of this study was to report our experience in the management of late morbidity after colonic interposition for caustic injury and to assess the influence of coloplasty dysfunction on patient outcome. Reports on coloplasty dysfunction after colon interposition for corrosive esophageal injuries are scarce in the literature. Dysfunction of the colonic substitute might jeopardize an already fragile functional result, and appropriate management can improve outcome. Long-term follow-up (>6 months) was conducted in 223 patients (125 men; median age, 35 years) who underwent colonic interposition for caustic injuries between 1987 and 2006. Statistical tests were performed on this cohort to identify risk factors for late morbidity and functional outcome. During the same period, 28 patients who underwent colon interposition for caustic injury in another center were referred for treatment of coloplasty dysfunction. Data from these patients were used together with those of our patients to describe specific coloplasty-related complications and their management. With a median follow-up of 5 years (range: 6 months-20 years), late complications were recorded in 125 (55%) of our patients (stenosis 36%, reflux 11%, redundancy 5%). A delay in reconstruction <6 months (P = 0.03) and absence of thoracic inlet enlargement (P = 0.002) were independent predictive factors for cervical anastomotic stenosis. Functional failure was recorded in 52 patients (23%) and was associated with a delay in reconstruction <6 months (P = 0.009) and emergency tracheotomy (P = 0.002). Coloplasty dysfunction was responsible for half of the recorded failures. Revision surgery for coloplasty dysfunction was performed in 96 patients (68 local, 28 referred) with an overall 70% success rate. Late complications occurred in half of the patients after colonic interposition for corrosive injuries and accounted for half of the functional failures. Prolonged surgical follow-up and appropriate management of coloplasty dysfunction are key factors for long-term success after esophageal reconstruction for caustic injuries.Keywords
This publication has 39 references indexed in Scilit:
- Colopharyngoplasty for the Treatment of Severe Pharyngoesophageal Caustic InjuriesAnnals of Surgery, 2007
- Esophageal reconstruction after caustic injury: is there still a place for right coloplasty?The American Journal of Surgery, 2007
- Does the interponat affect outcome after esophagectomy for cancer?*Diseases of the Esophagus, 2001
- German experience with colon interposition grafting as an esophageal substitute*Diseases of the Esophagus, 2001
- Extensive Abdominal Surgery After Caustic IngestionAnnals of Surgery, 2000
- Colon Interposition for Esophageal ReplacementAnnals of Surgery, 2000
- Bowel Interposition for Esophageal Replacement: Twenty-Five–Year ExperienceThe Annals of Thoracic Surgery, 1997
- Esophagocoloplasty in the Management of Postcorrosive Strictures of the EsophagusAnnals of Surgery, 1990
- Esophagoplasty for Corrosive Stricture of the EsophagusAnnals of Surgery, 1974
- The Use of Colon in the Surgical Treatment of Benign Stricture of the EsophagusAnnals of Surgery, 1964