Document Detail


Short-segment intestinal interposition of the distal esophagus.
MedLine Citation:
PMID:  8231208     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Esophageal replacement remains a challenge. Colon and jejunum provide alternative conduits to replace the lower esophagus when stomach is not suitable. Between 1971 and 1991, 41 patients underwent short-segment interposition of the esophagus with jejunum or colon. Indications were failed antireflux procedures (n = 21), nondilatable stricture (n = 9), achalasia (n = 2), moniliasis (n = 2), Barrett's esophagus with carcinoma in situ (n = 2), hemorrhagic esophagitis after esophagogastrectomy (n = 1), motility disorder (n = 1), instrumental perforation (n = 1), carcinoma (n = 1), and leiomyosarcoma (n = 1). Thirty-one patients (75.6%) had prior surgical procedures. Interposition with colon was performed in 22 patients and with jejunum in 19. Major complications occurred in 45% after colon interposition (10/22) and hospital mortality was 4.5% (1/22). Major complications after jejunal interposition occurred in 31% (6/19) and hospital mortality was 10.5% (2/19). A contained anastomotic leak occurred in 1 patient, perforation of a colon segment in 1, and jejunal graft necrosis in a third. Late functional results in 34 patients with a mean follow-up of 87 months were excellent or good in 26, fair in 5, and poor in 1. Colon interposition failed to improve symptoms in 2 patients with gastrointestinal motility disorders. Six patients underwent manometry and barium food provocation study. Two colon segments and 3 jejunal interpositions were hypoperistaltic or aperistaltic according to manometry. There was 1 case of aperistaltic jejunum with a distended afferent loop. When stomach is not available, successful palliation of swallowing can be accomplished with either jejunum or colon. Surgeons involved in the management of esophageal disease should be familiar with the technical details of both procedures.
Authors:
H A Gaissert; D J Mathisen; H C Grillo; R A Malt; J C Wain; A C Moncure; J H Kim; P R Mueller; R DeAngelis; L W Ottinger
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  106     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1993 Nov 
Date Detail:
Created Date:  1993-12-08     Completed Date:  1993-12-08     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  860-6; discussion 866-7     Citation Subset:  AIM; IM    
Affiliation:
Surgical Service, Massachusetts General Hospital, Boston 02114.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anastomosis, Surgical / methods
Colon / transplantation*
Esophageal Stenosis / surgery*
Esophagectomy / methods*
Female
Follow-Up Studies
Gastroesophageal Reflux / surgery*
Humans
Jejunum / transplantation*
Male
Middle Aged
Reoperation
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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