Long Term Results of Esophageal Bypass for Corrosive Strictures without Esophageal Resection Using a Modified Left Colon Esophagocoloplasty - A Report of 105 Consecutive Patients from a Single Unit Over 30 Years

Background/Aims: Esophageal stricture due to corrosive ingestion is a common cause of benign esophageal obstruction in developing countries. The immediate and long term results of surgical bypass using a modification of the left colon conduit, will be reviewed. Methodology: From 1977 to 2008, 105 patients underwent esophageal bypass for corrosive esophageal strictures using this procedure which has several modifications, detailed in the text, from the conventional left colon conduit. Results: Acids were the most common corrosive implicated (70.5%). Eighty nine patients underwent a bypass based on the left colic vessel through the substernal route. The subcutaneous route was used in the rest for varying reasons. Postoperatively three patients died. Conduit necrosis was seen in only one patient. Postoperative morbidity included pneumothorax in 15, cervical anastomotic stenosis in one, cervical anastomotic leak in 13 (less than 3% the last 75 cases) and recurrent laryngeal nerve palsy in 6 (5.7%). 72 patients had normal swallowing and 33 had only occasional minor difficulty with solid food on follow-up. Conclusions: Surgical bypass using a modification of the left colon esophagocoloplasty remains a reliable procedure with acceptable morbidity and good relief of dysphagia.