Arterial anatomic considerations in colon interposition for esophageal replacement.
BACKGROUND
Little has been written regarding the arterial anatomy predictive of success following esophagectomy and colon interposition.


METHODS
Retrospective review.


METHODS
University teaching hospital.


METHODS
Twenty-five patients undergoing planned left colon interposition.


METHODS
Colon interposition was performed via an isoperistaltic left colon graft based on the ascending branch of the left colic artery.


METHODS
Five angiographic features were considered important to successful use of the left colon: (1) a patient inferior mesenteric artery, (2) a visible ascending branch of the left colic artery, (3) a well-defined anastomosis between the middle colic and left colic systems, (4) a single middle colic trunk prior to its division into right and left branches, and (5) a separate origin of the right colic artery. Venous drainage via a patent marginal vein, inferior mesenteric vein, and superior hemorrhoidal veins was preserved in all patients.


RESULTS
Left colon interposition could be performed in 21 (84%) of 25 patients. Eighty percent of the patients (20/25) had at least four of the five criteria thought necessary for optimal graft perfusion. Three or fewer criteria were present in five patients, three of whom underwent gastric interposition. The inferior mesenteric artery was patent in all patients except one who required a right colon interposition. Ninety-two percent (23/25) demonstrated an adequate ascending left colic artery. The superior-inferior mesenteric artery anastomosis was seen in 52% (13/25). A single-trunked middle colic artery was present 80% (20/25) of the time. A single incidence of graft necrosis occurred secondary to venous insufficiency. Ninety-six percent of patients (24/25) were able to swallow without difficulty at the time of discharge from the hospital.


CONCLUSIONS
Replacement of the esophagus with colon can be successful in over 80% of patients screened by angiographic criteria. Patients with an occluded or stenotic inferior mesenteric artery or variant middle colic arterial anatomy should undergo an alternate reconstruction.
Peters
J H
JH
Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA.
Kronson
J W
JW
Katz
M
M
DeMeester
T R
TR
D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000098:blood supply* / Q000637:transplantation*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D018579:Patient Selection; D011300:Preoperative Care; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome