Reconstruction of The Cervical Esophagus by Visceral Interposition

Reconstruction of The Cervical Esophagus by Visceral Interposition



Various segments of abdominal viscera may be transposed or freely transplanted to replace portions of esophagus after resection or stenosis. The main advantage of these procedures, compared to reconstructions using skin (see Chapter 215), is that considerably longer segments of esophagus can be replaced. Visceral interpositions often can be performed in a single stage, thus permitting rapid rehabilitation of the esophagectomized patient; however, the magnitude of surgical trauma is generally greater than with skin reconstructions, and potentially disastrous complications may occur in association with necrosis or anastomotic failure. Thus, a greater degree of risk is assumed with these procedures than with reconstructions using skin to replace esophagus.


Reversed Gastric Tube

The reversed gastric tube is pedicled at the fundic end of the stomach and is based on the left gastroepiploic vessels. With splenectomy and mobilization of the tail of the pancreas, a sufficiently long conduit can be developed to easily reach the level of the oropharynx (Fig. 224.1).


Both right and left colon can be used for esophageal replacement. In theory, the right colon has the advantage of assuming an isoperistaltic orientation after interposition; however, a great length of the left colon can be pedicled on the middle colic vessels, and angiographic studies (12) confirmed that the
marginal artery of the colon is more consistent on the left side. Although the left colon assumes an antiperistaltic orientation when interposed, this has not proven functionally significant (Fig. 224.2).

FIGURE 224.1 Reverse gastric tube esophagoplasty. A: Pedicled tube from greater curvature. B: Final position of tube with anastomoses to pharynx. C: Alternate routes for tubed transfer to neck (subcutaneous, substernal, and posterior mediastinal). (From Silver, ref. 13, with permission.)

FIGURE 224.2 Esophagocoloplasty (left colon). A: Blood supply of colon—outline of transposed segment. B: Colon mobilized. C: Final position of interposed colon. (From Silver, ref. 13, with permission.)

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Jun 26, 2016 | Posted by in General Surgery | Comments Off on Reconstruction of The Cervical Esophagus by Visceral Interposition

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