[Prevention and treatment of anastomotic leakage and intestinal ischemia after esophageal replacement with colon].
OBJECTIVE
To explore the effective management to prevent anastomotic leakage and intestinal ischemia after esophageal replacement with colon(ERC).


METHODS
Clinical data of 572 cases received ERC from March 1966 to March 2006 were analyzed retrospectively.


RESULTS
Most of patients received ERC were diagnosed as esophageal cancer and esophageal stenosis(92.5%). 55.6% of cases underwent esophageal reconstruction and 44.4% of cases underwent esophageal bypass. During ERC procedure, the colon interposition graft length should be 3-4 cm longer than expectation; good blood supply was maintained; the lifted passage was unobstructed, and the physiological peristalsis direction was kept. The incidence of anastomotic leakage was analyzed among different periods, which were 14.2%, 13.5%, and 5.6% during 1966-1975, 1976-1995 and 1996-2006 respectively(P<0.05). No intestinal ischemia was observed in all the patients.


CONCLUSIONS
When performing ERC, the main preventional managements of anastomotic leakage and intestinal ischemia are fully blood supply maintenance and intercepting enough length of the colon graft. Ensuring unobstructed passage is good for survival of the colon graft. Correct physiological peristalsis direction of colon interposition is beneficial to the healing of the anastomosis.
Xia
Jun
J
Department of Cardiothoracic Surgery, Renmin Hospital, Wuhan University, Wuhan 430060, China. xiajunml@yahoo.com
Peng
Yi
Y
Huang
Jie
J
Cheng
Bang-Chang
BC
Wang
Zhi-Wei
ZW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000637:transplantation; D004947:Esophagus / Q000601:surgery; D005260:Female; D005402:Fistula / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology / Q000517:prevention & control*; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D054047:Surgical Stomas / Q000473:pathology; D055815:Young Adult