Colon Interposition

Abstract

In the anatomy of the colon vasculature, the ascending branch of the left colic artery is the primary supplying vessel (96.91%). Isoperistaltic transposition of the transverse colon is preferred (83.58%). Riolan’s vascular arcade is not a major vessel of the colon. It can only be found in less than 10% of patients, and whether or not this arcade is complete cannot be used as criterion to judge colon blood supply. Animal experiments and clinical studies have confirmed the superiority of one-layer over two-layer anastomosis. The former is simpler, safer, and more reliable, with a lower incidence of anastomotic leak or stricture. Based on a comprehensive evaluation of the disease type, patient age, heart and lung functions, nutritional status, and accompanying diseases, three colon transposition routes are available (anterosternal subcutaneous tunnel, retrosternal tunnel, and esophageal bed passage). The advantages and disadvantages of each route are analyzed, and the left-middle-left retrosternal route is described. The indications for esophageal reconstruction with colon operation (ERC) were collected and verified, increasing the number of indications to seven categories of diseases. The main complications of ERC, i.e., colon segment necrosis, anastomotic leak, recurrent laryngeal nerve injury, and intestinal obstruction were systematically studied, and their causes and prevention are detailed. The number of patients is the highest in a single unit among all the published reports. The incidence of complications and deaths are the lowest.