Operations to Replace or Bypass the Esophagus: Colon or Jejunum Interposition; Transhiatal Esophagectomy with Gastric Pull-Up

Abstract

Using the colon (or jejunum) to replace resected segment of the esophagus permits the surgeon to preserve intact a functioning stomach. Performing the cologastric anastomosis 10 cm down from the gastric cardia will generally minimize gastrocolic reflux. Achieving a sufficient length of viable colon is, with rare exceptions, feasible. One drawback to using the colon as a substitute esophagus is the risk of impairing the venous blood flow either by injuring the veins in the colon mesentery or impairing venous return by leaving an inadequate aperture in the diaphragm or at the apex of the thorax for the colon and its mesentery. Under these conditions venous infarction can occur. Following careful surgery, this complication should be quite rare. Belsey experienced one colon infarct in 92 left colon interposition operations. This complication appears to be more common when the right colon is used as opposed to the left colon (Wilkins).