title: Colon interposition for esophageal replacement: a single-center experience.
abstract: BACKGROUND
  Gastric tube interposition has become the method of choice for esophageal replacement after esophagectomy. Colon interposition, on the other hand, is widely considered to be a method of last resort, associated with high morbidity and mortality. The present study reviews our experience with colon interposition for esophageal replacement.
  
  
  METHODS
  Nineteen consecutive patients undergoing colon interposition for esophageal replacement between 1 January 1994 and 31 July 2001 were reviewed. Outcome was compared with international publications on colon interposition as well as with our results following gastric tube interposition (fundus rotation gastroplasty).
  
  
  RESULTS
  Fourteen men and five women with a median age of 68 years (range 44-78) underwent colon interposition for benign ( n=9) and malignant ( n=10) lesions. Eighteen patients underwent trans-hiatal esophagectomy with cervical anastomosis, and one patient underwent thoraco-abdominal esophagectomy with intrathoracic anastomosis. Surgical morbidity was 36.8% (7/19). Anastomotic insufficiency and fatal mediastinal bleeding occurred in one patient each (5.3%). No cases of graft necrosis were observed, and no re-operations were necessary. In-hospital mortality was 15.8% (3/19), twice due to surgical complications (abdominal sepsis, mediastinal bleeding) and once due to pulmonary and cardiac failure. As a late complication, four patients (21.1%) developed anastomotic strictures that necessitated repeated endoscopic dilatation.
  
  
  CONCLUSIONS
  Gastric tube interposition remains the method of choice for esophageal replacement. Colon interposition, however, is a valuable alternative with a good long-term function. Early mortality, however, remains a matter of serious concern.
authors.affiliation: Department of Visceral and Transplantation Surgery, University of Berne, Inselspital, Switzerland.
authors.forename: Pietro
authors.initials: P
authors.lastname: Renzulli
authors.forename: Alexander
authors.initials: A
authors.lastname: Joeris
authors.forename: Oliver
authors.initials: O
authors.lastname: Strobel
authors.forename: Annemarie
authors.initials: A
authors.lastname: Hilt
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Maurer
authors.forename: Waldemar
authors.initials: W
authors.lastname: Uhl
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
mesh_terms: D000328:Adult; D000368:Aged; D003106:Colon / Q000637:transplantation*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004935:Esophageal Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome