Reoperative surgery for colon conduit failure: a major challenge in esophageal reconstruction

Colon interposition is a second-line reconstructive option after esophagectomy for carcinoma, caustic or peptic lesions refractory to dilatation, perforation or trauma, and end-stage achalasia (1); in other instances, such as prior gastrectomy, necessity of concomitant gastrectomy for syncronous gastric tumors, extensive gastric damage from caustic ingestion, proximal squamous-cell carcinoma, or failures of previous gastric pull-up, the stomach may not be available as a first-choice conduit or an extra-long graft may be required to reach the hypopharynx (2). The most typical colon transplant is a long graft with an upper intrathoracic or neck anastomosis, and location of the anastomosis depends on the route of colon interposition. A retrosternal route and a cervical esophago-colic anastomosis is generally preferred in patients with “hostile” mediastinum from previous thoracotomy or radiotherapy, or as a second-stage “bypass” procedure following emergency esophagectomy or esophageal exclusion and diversion (3). Rarely, when the retrosternal route is not viable due to previous sternotomy, the colonic graft can primarily be placed antesternally through a subcutaneous tunnel.