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Colonic interposition, a contemporary experience: technical aspects and outcomes

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Abstract

Colonic interposition is rarely used as an oesophageal replacement after resection, as the preferred use of stomach involves less anastomoses and lower risks of major complications. The functional outcome from the colonic conduit is also unpredictable. This report documents the spectrum of experience of a high-volume oesophageal centre, highlighting indications, techniques and functional outcomes. A retrospective review was undertaken of a prospective database from 2012 to 2016. Four of 252 (1.5%) cases in this time period utilised colon interposition. Two cases were for gastric conduit necrosis following oesophageal cancer resections, one for caustic ingestion with both an oesophago-bronchial fistula and gastric injury, and one for a primary oesophageal malignancy in a patient whom previously had a total gastrectomy. All patients had either a retrosternal or posterior mediastinal isoperistaltic right colon conduit placed. Two of three cancer patients are alive and disease free at 3 and 5 years, respectively. Surviving patients are weight stable and tolerating a normal diet. Both report excellent quality of life using validated assessment tools. Colonic interposition is rarely required in modern oesophageal practice, but with this technique good long-term nutritional and functional outcomes can be obtained. It is required in the armamentarium of a specialist centre, and training given its rarity may require novel approaches such as simulation and cadaveric-based training

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

The authors did not receive any financial support for this study.

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Authors and Affiliations

  1. The National Oesophageal and Gastric Cancer Centre, St James Hospital, Dublin 8, Ireland

    Naomi M. Fearon, Helen M. Mohan, Michelle Fanning, Narayanasamy Ravi & John V. Reynolds

Authors
  1. Naomi M. Fearon
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  2. Helen M. Mohan
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  3. Michelle Fanning
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  4. Narayanasamy Ravi
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  5. John V. Reynolds
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Contributions

JVR and NR contributed to the study conception and design. Data collection and data analyses were performed by MF and NMF. The manuscript was written by NF, MF and HMM. All the authors reviewed and edited the manuscript. All the authors read and approved the final manuscript.

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Correspondence to Naomi M. Fearon.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was obtained from alive patients.

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Fearon, N.M., Mohan, H.M., Fanning, M. et al. Colonic interposition, a contemporary experience: technical aspects and outcomes. Updates Surg 73, 1849–1855 (2021). https://doi.org/10.1007/s13304-020-00920-5

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  • DOI: https://doi.org/10.1007/s13304-020-00920-5

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