Reconstrucción Esofágica con Coloplastía Derecha tras Ingesta de Caústicos

Esophageal reconstruction after caustic injury: is there still a place for right coloplasty?

The American Journal of Surgery 2007;193(6):660-664

Hervé Bothereau M, Nicolas Munoz-Bongrand, Benoît Lambert, Sébastino Montemagno, Pierre Cattan and Emile Sarfati
Department of Digestive and Endocrine Surgery, Saint-Louis Hospital,Paris, France

Background

Through a systematic policy of using the right colon as an esophageal substitute, the authors analyze the reliability of this transplant for reconstruction after digestive caustic injury.

Methods

From 1995 to 2005, a right coloplasty was attempted in 81 patients after total esophagogastrectomy (n = 57) or for esophageal stricture (n = 24).

Results

The use of the right colon was not possible in 10 patients (12%) because of insufficient blood supply. In addition, postoperative right colic graft necrosis occurred in 5 patients. Cervical fistula occurred in 25 patients (31%). Opening of the thoracic inlet was associated with a lower rate of this complication (P = .04). At the end of the follow-up, 71 patients (88%) recovered oral feeding.

Conclusion

Attempt to use the right colon as an esophageal substitute failed in 18% of the patients. Despite high rates of cervical complications, in part linked to the peculiar setting of caustic injury, functional results remains satisfactory.