Colonic Esophageal Reconstruction by Substernal Approach for Caustic Stricture: What is the Impact of the Enlargement of the Thoracic Inlet on Cervical Anastomotic Complications?

A Boukerrouche
2014 Jurnalul de Chirurgie   unpublished
Introduction The construction of a long graft requires the sacrifice of the blood supply, leading to reduced circulation to the graft. The key point of Esophageal reconstruction is to ensure that the cervical anastomosis is without tension by using a graft with sufficient length and sufficient blood supply. Colon interposition is the method of choice to restore the digestive tract after esogastrectomie or for caustic stricture. Isoperistaltic left colic transplant supplied by the left colic
more » ... the left colic pedicle and interposed by RS is an excellent long-term replacement organ for an esophageal caustic stricture. When performed by an experienced surgeon, it is an effective procedure with acceptable operative mortality, early morbidity, and good long-term functional results [1]. There are multiple options for the placement of the digestive conduit therefore the two most commonly employed options are the posterior mediastinal route and the retrosternal route. The use of the mediastinal route needs the ablation of the native esophagus .This and other disadvantages of the posterior mediastinal (PM) route have prompted some surgeons to advocate an alternate route of reconstruction, namely the retrosternal (RS) approach. In 1955, Dale and Sherman firstly introduced colonic reconstruction by retrosternal approach [2]. Therefore, the biggest disadvantage of the retrosternal approach is the potential risk for compression of the graft at the site of the thoracic inlet, which can lead to mechanical ischemia. To prevent this event, some surgeons suggested to the enlarge of the thoracic inlet [3-5]. The aim of this study is to report the impact of the enlargement of the thoracic inlet on the cervical anastomotic leakage after sub sternal colonic interposition for esophageal caustic stricture. The purpose of this study is to report our results by analyzing the impact of the enlargement of the thoracic inlet by removing the left half of manubrium and internal third of clavicle on the cervical anastomotic complications. Patients and Methods Patients In a continuous prospective study conducted from 2005 to 2013, 82 left colonic interpositions for oesophageal caustic stricture were performed at our institution. There were 70 women (85, 3%) and 12 men (14.6%). The mean age of patients was 25 years (ranging 15 to 70). Ten patients (12.1%) had a hypopharyngeal stricture that required also reconstructive surgery. Fifty five patients with esophageal caustic stricture had undergone previous dilation. Median delay from caustic injury to chirurgical reconstruction was 12 months (ranging 3 months to 10 years). Abstract Background: The two most commonly employed options for esophageal reconstruction are the posterior mediastinal route and the substernal route. Therefore, the biggest disadvantage of the retrosternal approach is the potential risk for compression of the graft at the site of the thoracic inlet. The purpose of this study is to report our results by analysing the impact of the enlargement of the thoracic inlet by removing the left half of manubrium and internal third of clavicle on the cervical anastomotic leakage.
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