Severe Functional Disorders after Colic Oesophagoplasty for Caustic Stenosis: Treatment and Prevention

Seance of wednesday 09 december 2015 (SÉANCE FRANCO-ALGÉRIENNE VASCULAIRE et VISCÉRALE)

Abstract

The aim of this study was to report the severe functional disturbances following left colic oesophagoplasty, evaluate therapeutic modalities and propose preventive measures.Methods: From January 2000 to January 2014, 112 patients had left colic oesophagoplasty for caustic esophageal stricture. One hundred and two patients remained in the final study due to lost to (n = 07) and died (n = 03). Fourteen patients (13%) had severe functional impairment that required additional endoscopic or surgical treatment.Results: Functional disorders were kind of dysphagia (n = 08), gastro-colicl reflux (n = 4) and pneumonia (n = 2). Dysphagia was associated with oeso-colic (n = 6), pharyngo colic (n = 1) and the total left colic (n = 1) anastomotic stenosis. The gastro-colic severe reflux (n = 4) was observed after aniso peristaltic oesophagoplasty (n = 1), colo-jejunal anastomosis on the first jejunal loop (n = 1) and gastric emptying disorder (n = 2). The nickname cervical diverticulum occurred in patients who had oeso-colonic termino lateral anastomosis (n = 2). Treatment of anastomotic stenosis was endoscopic by dilations (n = 03) and CO2 laser drilling (n = 1). Surgical treatment of these strictures (n = 04) was resection of oeso colic anastomosis (n = 2), stricturoplasty (n = 1) and ileo-coloplasty (n = 1). After failure of medical treatment, the gastro colic was treated with a total duodenal diversion (n = 1), resection of colo-gastric stenosis associated with pyloroplasty (n = 1), Single pyloroplasty (n = 1) and colo-jejunal anastomosis on a y loop (n = 1). The nickname diverticulum was resected with end-to end anastomosis (n = 2).Conclusion: The colic oesophagoplasty technique requires attention to detail. The long-term monitoring of patients is necessary because the possibility of reoperation is not excluded.