Colon patch esophagoplasty: An alternative to total esophagus replacement?

Background: Resistant benign esophageal strictures (ES) are likely to require esophageal replacement. The use of colon patch esophagoplasty (CPE) was originally described for the correction of long segment esophageal stenosis, however it was thought that the length of the stricture would limit the use of the patch technique. We performed CPE on 3- to 4-inch strictures with a good outcome. Aim: We report here on our results of the use of CPE for long and short ES. Patients and Methods: A retrospective study was carried out oil patients operated for resistant ES using a vascularized colonic patch. The technique used was the same as described by Hecker and Hollmann with a few modifications. We used the right colon. Instead of passing the patch through the hiatus we placed it in the right pleural cavity through a small incision in the diaphragm, An appropriately sized patch was sewn to a generous longitudinal esophagotomy extending well beyond the Stricture using running 4/0 polydiaxone sutures. Results: Four patients underwent CPE, three because of an extensive caustic stricture and one with a Stricture after failed atresia repair. All four patients were males. They were almost the same age except for the one with post-tracheoesophageal fistula (TEF) repair stricture. The site of the Stricture was the mid esophagus in three and the lower esophagus in one. Three patients had an anastomatic leak which was treated conservatively and one patient required a postoperative fundoplication 10 days post-CPE to stop the leak. The first patient developed a patch diverticulum, which was resected 12 years after CPE. All had fundoplication pre-, intra- or post-CPE. The follow-up period ranged from 4-20 years. All patients are eating and growing normally after surgery. No malignant changes were seen in the older patient. Conclusions: The length of the stricture is not a problem in CPE. Our results are encouraging on the use of CPE as an alternative to esophageal replacement. We suggest using CPE even for an entire scarred esophagus. A postoperative leak due to a long suture line can be overcome by fundoplication and supportive therapy.