title: Late morbidity after colon interposition for corrosive esophageal injury: risk factors, management, and outcome. A 20-years experience.
abstract: OBJECTIVE
  The aim of this study was to report our experience in the management of late morbidity after colonic interposition for caustic injury and to assess the influence of coloplasty dysfunction on patient outcome.
  
  
  BACKGROUND
  Reports on coloplasty dysfunction after colon interposition for corrosive esophageal injuries are scarce in the literature. Dysfunction of the colonic substitute might jeopardize an already fragile functional result, and appropriate management can improve outcome.
  
  
  METHODS
  Long-term follow-up (>6 months) was conducted in 223 patients (125 men; median age, 35 years) who underwent colonic interposition for caustic injuries between 1987 and 2006. Statistical tests were performed on this cohort to identify risk factors for late morbidity and functional outcome. During the same period, 28 patients who underwent colon interposition for caustic injury in another center were referred for treatment of coloplasty dysfunction. Data from these patients were used together with those of our patients to describe specific coloplasty-related complications and their management.
  
  
  RESULTS
  With a median follow-up of 5 years (range: 6 months-20 years), late complications were recorded in 125 (55%) of our patients (stenosis 36%, reflux 11%, redundancy 5%). A delay in reconstruction <6 months (P = 0.03) and absence of thoracic inlet enlargement (P = 0.002) were independent predictive factors for cervical anastomotic stenosis. Functional failure was recorded in 52 patients (23%) and was associated with a delay in reconstruction <6 months (P = 0.009) and emergency tracheotomy (P = 0.002). Coloplasty dysfunction was responsible for half of the recorded failures. Revision surgery for coloplasty dysfunction was performed in 96 patients (68 local, 28 referred) with an overall 70% success rate.
  
  
  CONCLUSIONS
  Late complications occurred in half of the patients after colonic interposition for corrosive injuries and accounted for half of the functional failures. Prolonged surgical follow-up and appropriate management of coloplasty dysfunction are key factors for long-term success after esophageal reconstruction for caustic injuries.
authors.affiliation: Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Paris, France.
authors.forename: Mircea
authors.initials: M
authors.lastname: Chirica
authors.forename: Nicolas
authors.initials: N
authors.lastname: Veyrie
authors.forename: Nicolas
authors.initials: N
authors.lastname: Munoz-Bongrand
authors.forename: Sarah
authors.initials: S
authors.lastname: Zohar
authors.forename: Bruno
authors.initials: B
authors.lastname: Halimi
authors.forename: Michel
authors.initials: M
authors.lastname: Celerier
authors.forename: Pierre
authors.initials: P
authors.lastname: Cattan
authors.forename: Emile
authors.initials: E
authors.lastname: Sarfati
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002057:Burns, Chemical / Q000601:surgery*; D002424:Caustics / Q000633:toxicity*; D003106:Colon / Q000637:transplantation*; D004940:Esophageal Stenosis / Q000139:chemically induced* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D002424:Caustics