nach oben

European Surgery

Erschienen in:

03.06.2022 | original article

A renovated method of performing over 258 cases of pedicled colon segment interposition for esophageal reconstruction with integration of plastic surgery principles into general surgery procedure

verfasst von: Associate Professor Burak Kaya, MD, PhD, Shih-heng Chen, MD, PhD, Professor Hung-chi Chen, MD, PhD, FACS

Erschienen in: European Surgery | Ausgabe 5/2022

Einloggen, um Zugang zu erhalten

Summary

Background

In the field of reconstruction, there is always room for improvement of results regarding safety, functions, esthetics, and a decrease in complications and morbidities. A complex procedure such as conventional colon segment interposition for esophageal reconstruction can be improved by integrating plastic surgery principles.

Methods

A retrospective study was carried out. Esophagectomies are performed due to malignant diseases such as squamous cell carcinoma of the esophagus and hypopharynx, or benign conditions such as caustic injuries. From 1983 to 2018, a renovated method of colon segment interposition was developed and performed under the collaboration of plastic and general surgeons. It included the following features: 1. skin incision at the neck; 2. identification of the recurrent laryngeal nerve and superior laryngeal nerve; 3. stent placement across the proximal anastomotic site; 4. use of a diversion loop when there is damage of the epiglottis; 5. instruments to create a wide substernal tunnel; 6. supercharge of vessels at the neck to augment the blood supply of the colon segment, indicated in patients with arteriosclerosis and anatomical variation of the colon due to congenital variation or following abdominal trauma; 7. use of a seromuscular flap; 8. use of intraluminal and extraluminal drains at the neck.

Results

In the 258 cases, there was no failed reconstruction, no hoarseness due to nerve damage, and only 2 patients with leakage, which was repaired secondarily. Average follow-up was 8.3 years. Average time to oral intake after completion of reconstruction was 20.4 days.

Conclusion

Brainstorming and collaboration among different subspecialties may lead to solutions for complex problems or improvement of a surgical procedure. To avoid complications of colon segment interposition, the eight steps mentioned above should be highlighted.

Vorheriger Artikel eSurgery—digital transformation in surgery, surgical education and training: survey analysis of the status quo in Germany

Nächster Artikel Interprofessional differences in preoperative planning—the individualist surgeon

Lo OS, Law S, Wei WI, et al. Esophageal cancers with synchronous or antecedent head and neck cancers: a more formidable challenge? Ann Surg Oncol. 2008;15(6):1750–6. https://doi.org/10.1245/s10434-008-9860-y.CrossRefPubMed

Mormando J, Barbetta A, Molena D. Esophagectomy for benign disease. J Thorac Dis. 2018;10(3):2026–33. https://doi.org/10.21037/jtd.2018.01.165.CrossRefPubMedPubMedCentral

Yeo CJ. Chapter 41, Options for esophageal replacement. In: Shackelford’s surgery of the alimentary tract. 8th ed. Philadelphia: Elsevier; 2019. pp. 438–66.

Mine S, Udagawa H, Tsutsumi K, et al. Colon interposition after esophagectomy with extended lymphadenectomy for esophageal cancer. Ann Thorac Surg. 2009;88(5):1647–53. https://doi.org/10.1016/j.athoracsur.2009.05.081.CrossRefPubMed

Reslinger V, Tranchart H, D’Annunzio E, et al. Esophageal reconstruction by colon interposition after esophagectomy for cancer analysis of current indications, operative outcomes, and long-term survival. J Surg Oncol. 2016;113(2):159–64. https://doi.org/10.1002/jso.24118.CrossRefPubMed

Chirica M, Vuarnesson H, Zohar S, et al. Similar outcomes after primary and secondary esophagocoloplasty for caustic injuries. Ann Thorac Surg. 2012;93(3):905–12. https://doi.org/10.1016/j.athoracsur.2011.12.054.CrossRefPubMed

Wain JC, Wright CD, Kuo EY, et al. Long-segment colon interposition for acquired esophageal disease. Ann Thorac Surg. 1999;67(2):313–7. https://doi.org/10.1016/s0003-4975(99)00029-6. discussion 317–318.CrossRefPubMed

Davis PA, Law S, Wong J. Colonic interposition after esophagectomy for cancer. Arch Surg. 2003;138(3):303–8. https://doi.org/10.1001/archsurg.138.3.303.CrossRefPubMed

Chirica M, Veyrie N, Munoz-Bongrand N, et al. Late morbidity after colon interposition for corrosive esophageal injury: risk factors, management, and outcome. A 20-years experience. Ann Surg. 2010;252(2):271–80. https://doi.org/10.1097/SLA.0b013e3181e8fd40.CrossRefPubMed

10.

Brown J, Lewis WG, Foliaki A, Clark GWB, Blackshaw G, Chan DSY. Colonic interposition after adult oesophagectomy: systematic review and meta-analysis of conduit choice and outcome. J Gastrointest Surg. 2018;22(6):1104–11. https://doi.org/10.1007/s11605-018-3735-8.CrossRefPubMed

11.

Lee K, Kim HR, Park SI, Kim DK, Kim YH, Choi SH. Surgical outcome of colon interposition in esophageal cancer surgery: analysis of risk factors for conduit-related morbidity. Thorac Cardiovasc Surg. 2018;66(5):384–9. https://doi.org/10.1055/s-0037-1606828.CrossRefPubMed

12.

Longaker MT, Rohrich RJ. Innovation: a sustainable competitive advantage for plastic and reconstructive surgery. Plast Reconstr Surg. 2005;115(7):2135–6. https://doi.org/10.1097/01.prs.0000168495.95560.eb.CrossRefPubMed

13.

Ong GB, Lee TC. Pharyngogastric anastomosis after oesophago-pharyngectomy for carcinoma of the hypopharynx and cervical oesophagus. Br J Surg. 1960;48:193–200. https://doi.org/10.1002/bjs.18004820823.CrossRefPubMed

14.

DeMeester SR. Colon interposition following esophagectomy. Dis Esophagus. 2001;14(3–4):169–72. https://doi.org/10.1046/j.1442-2050.2001.00180.x.CrossRefPubMed

15.

Chen HC, Tang YB. Microsurgical reconstruction of the esophagus. Semin Surg Oncol. 2000;19(3):235–45. https://doi.org/10.1002/1098-2388(200010/11)19:3%3C235::AID-SSU5%3E3.0.CO;2-M.CrossRefPubMed

16.

Coleman JJ 3rd. Reconstruction of the pharynx and cervical esophagus. Semin Surg Oncol. 1995;11(3):208–20. https://doi.org/10.1002/ssu.2980110306.CrossRefPubMed

17.

Yang S, Hong JW, Yoon IS, Lew DH, Roh TS, Lee WJ. Anterolateral thigh free flaps and radial forearm free flaps in head and neck reconstruction: A 20-year analysis from a single institution. Arch Plast Surg. 2021;48(1):49–54. https://doi.org/10.5999/aps.2020.01529.CrossRefPubMedPubMedCentral

18.

Lee GK, Yamin F, Ho OH. Vertical island trapezius myocutaneous flap for cervical esophagoplasty: case report and review of the literature. Ann Plast Surg. 2012;68(4):362–5. https://doi.org/10.1097/SAP.0b013e31823b68eb.CrossRefPubMed

19.

Shen KR, Austen WG Jr., Mathisen DJ. Use of a prefabricated pectoralis major muscle flap and pedicled jejunal interposition graft for salvage esophageal reconstruction after failed gastric pull-up and colon interposition. J Thorac Cardiovasc Surg. 2008;135(5):1186–7. https://doi.org/10.1016/j.jtcvs.2007.08.079.CrossRefPubMed

20.

Kelling G. Oesophagoplastik mit Hilf des Querkolon. Semin Med. 1911;38:1209–12.

21.

Doki Y, Okada K, Miyata H, et al. Long-term and short-term evaluation of esophageal reconstruction using the colon or the jejunum in esophageal cancer patients after gastrectomy. Dis Esophagus. 2008;21(2):132–8. https://doi.org/10.1111/j.1442-2050.2007.00738.x.CrossRefPubMed

22.

Briel JW, Tamhankar AP, Hagen JA, DeMeester SR, Johansson J, Choustoulakis E, Peters JH, Bremner CG, DeMeester TR. Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg. 2004;198(4):536–41. https://doi.org/10.1016/j.jamcollsurg.2003.11.026. discussion 541–532.CrossRefPubMed

23.

Gallo G, Zwaveling S, Groen H, Van der Zee D, Hulscher J. Long-gap esophageal atresia: a meta-analysis of jejunal interposition, colon interposition, and gastric pull-up. Eur J Pediatr Surg. 2012;22(6):420–5. https://doi.org/10.1055/s-0032-1331459.CrossRefPubMed

24.

Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC. Esophageal replacement by colon interposition. Ann Thorac Surg. 1995;59(6):1382–4. https://doi.org/10.1016/0003-4975(95)00182-k.CrossRefPubMed

25.

Zenn MR, Jones GJ. Chapter 1, surgical decision-making: options, principles, and techniques. In: Reconstructive surgery: anatomy, technique, and clinical applications. St. Louis: Quality Medical; 2012. pp. 7–34.

26.

Broughton G 2nd, Janis JE, Attinger CE. Wound healing: an overview. Plast Reconstr Surg. 2006;117(7 Suppl):1e–S–32e–S. https://doi.org/10.1097/01.prs.0000222562.60260.f9.CrossRef

27.

Myers WT, Leong M, Phillips LG. Optimizing the patient for surgical treatment of the wound. Clin Plast Surg. 2007;34(4):607–20. https://doi.org/10.1016/j.cps.2007.07.002.CrossRefPubMed

28.

Evans BC, Evans GR. Microvascular surgery. Plast Reconstr Surg. 2007;119(2):18e–30e. https://doi.org/10.1097/01.prs.0000246717.81077.e4.CrossRefPubMed

29.

Millard DR. Principlization of plastic surgery. Boston, Toronto: Little Brown & Co; 1986.

30.

Wormuth JK, Heitmiller RF. Esophageal conduit necrosis. Thorac Surg Clin. 2006;16(1):11–22. https://doi.org/10.1016/j.thorsurg.2006.01.003.CrossRefPubMed

31.

Golshani SD, Lee C, Cass D, Thomas A, Mandpe AH. Microvascular “supercharged” cervical colon: minimizing ischemia in esophageal reconstruction. Ann Plast Surg. 1999;43(5):533–8. https://doi.org/10.1097/00000637-199911000-00012.CrossRefPubMed

32.

Sert G, Chen SH, Chen HC. How to ensure immediate and long-term good blood supply by the careful dissection of the marginal artery and supercharge with neck vessels in esophageal reconstruction with the colon segment interposition: 35 years of experience. J Plast Reconstr Aesthet Surg. 2021;74(1):101–7. https://doi.org/10.1016/j.bjps.2020.08.013.CrossRefPubMed

33.

Schwabegger AH, Engelhardt TO, Jeschke J. Stabilization of microvascular pedicles in intricate locations using fibrin glue. Microsurgery. 2008;28(7):509–13. https://doi.org/10.1002/micr.20536. discussion 514–505.CrossRefPubMed

34.

Moorehead RJ, Wong J. Gangrene in esophageal substitutes after resection and bypass procedures for carcinoma of the esophagus. Hepatogastroenterology. 1990;37(4):364–7.PubMed

35.

Cigna E, Chen HC, Spanio S, et al. A new technique for substernal colon transposition with a breast dissector: report of 39 cases. J Plast Reconstr Aesthet Surg. 2006;59(4):343–6. https://doi.org/10.1016/j.bjps.2005.09.041.CrossRefPubMed

36.

Reece GP, Schusterman MA, Miller MJ, et al. Morbidity and functional outcome of free jejunal transfer reconstruction for circumferential defects of the pharynx and cervical esophagus. Plast Reconstr Surg. 1995;96(6):1307–16. https://doi.org/10.1097/00006534-199511000-00012.CrossRefPubMed

37.

Chang DW, Hussussian C, Lewin JS, Youssef AA, Robb GL, Reece GP. Analysis of pharyngocutaneous fistula following free jejunal transfer for total laryngopharyngectomy. Plast Reconstr Surg. 2002;109(5):1522–7. https://doi.org/10.1097/00006534-200204150-00006.CrossRefPubMed

38.

Scott JC, Jones B, Eisele DW, Ravich WJ. Caustic ingestion injuries of the upper aerodigestive tract. Laryngoscope. 1992;102(1):1–8. https://doi.org/10.1288/00005537-199201000-00001.CrossRefPubMed

39.

Chen HC, Chana JS, Chang CH, Feng GM, Ho-Asjoe M, Tang YB. A new method of subcutaneous placement of free jejunal flaps to reconstruct a diversionary conduit for swallowing in complicated pharyngoesophageal injury. Plast Reconstr Surg. 2003;112(6):1528–33. https://doi.org/10.1097/01.PRS.0000083377.41505.BB.CrossRefPubMed

40.

Crumley RL. Repair of the recurrent laryngeal nerve. Otolaryngol Clin North Am. 1990;23(3):553–63.CrossRef

41.

Baba M, Natsugoe S, Shimada M, et al. Does hoarseness of voice from recurrent nerve paralysis after esophagectomy for carcinoma influence patient quality of life? J Am Coll Surg. 1999;188(3):231–6. https://doi.org/10.1016/s1072-7515(98)00295-6.CrossRefPubMed

42.

Koyanagi K, Igaki H, Iwabu J, Ochiai H, Tachimori Y. Recurrent laryngeal nerve paralysis after esophagectomy: respiratory complications and role of nerve reconstruction. Tohoku J Exp Med. 2015;237(1):1–8. https://doi.org/10.1620/tjem.237.1.CrossRefPubMed

43.

Zhong D, Zhou Y, Li Y, et al. Intraoperative recurrent laryngeal nerve monitoring: a useful method for patients with esophageal cancer. Dis Esophagus. 2014;27(5):444–51. https://doi.org/10.1111/j.1442-2050.2012.01414.x.CrossRefPubMed

44.

Koyanagi K, Kato F, Nakanishi K, Ozawa S. Lateral thermal spread and recurrent laryngeal nerve paralysis after minimally invasive esophagectomy in bipolar vessel sealing and ultrasonic energy devices: a comparative study. Esophagus. 2018;15(4):249–55. https://doi.org/10.1007/s10388-018-0621-0.CrossRefPubMed

45.

Sert G, Chen SH, Aksoyler DY, Chen HC. Preliminary dissection of recurrent laryngeal nerve during esophageal reconstruction for corrosive esophageal injury. Microsurgery. 2020;40(7):825–6. https://doi.org/10.1002/micr.30624.CrossRefPubMed

46.

Harrison B, Khansa I, Janis JE. Evidence-based strategies to reduce postoperative complications in plastic surgery. Plast Reconstr Surg. 2016;138(3 Suppl):51S–60S. https://doi.org/10.1097/PRS.0000000000002774.CrossRefPubMed

47.

Rohrich RJ, Timberlake AT, Afrooz PN. Revisiting the fundamental operative principles of plastic surgery. Plast Reconstr Surg. 2017;140(6):1315–8. https://doi.org/10.1097/PRS.0000000000003909.CrossRefPubMed

Titel: A renovated method of performing over 258 cases of pedicled colon segment interposition for esophageal reconstruction with integration of plastic surgery principles into general surgery procedure
verfasst von: Associate Professor Burak Kaya, MD, PhD
Shih-heng Chen, MD, PhD
Professor Hung-chi Chen, MD, PhD, FACS
Publikationsdatum: 03.06.2022
Verlag: Springer Vienna
Erschienen in: European Surgery / Ausgabe 5/2022
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI: https://doi.org/10.1007/s10353-022-00766-8

Springer Medizin Österreich

Summary

Background

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2022

Interprofessional differences in preoperative planning—the individualist surgeon

The positive quanta of surgery: one little bird echoes the great pause

International Surgical Week 2022—Selected highlights

International Surgical Week 2022

Raimund Margreiter: My life dedicated to Surgery

Dysphagia aortica