P-197ADVANCEMENT COLOPLASTY FOR RESTORATION OF CONTINUITY AFTER SEGMENTAL LOSS OF COLON IN LONG SEGMENT COLON INTERPOSITION: SINGLE INSTITUTION EXPERIENCE

Abstract

Objectives: Complex pharyngo-oesophageal strictures due to corrosive ingestion requires oesophageal replacement by either gastric or colonic pull-up. While colonic pull-up up to the neck may cause total or partial ischaemia to the conduit due to traction (or) tension of vascular pedicle. Partial ischaemia of the conduit results in upper end of conduit necrosis, which leads to total dysphagia causing failure of coloplasty. We are describing the new technique to bridge the short segment conduit loss by advancing the available redundant colon with intact pedicle. Methods: Three patients underwent advancement of the redundant colon conduit in our institution. Median sternotomy was done in all three patients and adhesions of the colon conduit were released. Abdominal mobilization was done with care taken to protect the vascular pedicle. Primary neck anastomosis was done in the same operation in 2 patients and in the other patient, colon was left in the neck without anastomosis which was completed in a second sitting. Results: There was no leak or stenosis. Conclusions: Failure of high pharyngocolic anastomosis is a difficult situation to manage. This requires revision surgery for its management. Many people have opted for doing an interpositional jejunal graft with microvascular anastomosis. We have described a new technique using the available colon, which can be advanced. In patients with redundant colon conduit, we have found that redundancy can be utilized to take the conduit further up for revision anastomosis.