[Reinterventions for complication and defect of coloesophagoplasty]

Circumferential Pharyngoesophageal Reconstruction and Total Larynx Preservation with Extra-anatomical Free Flaps

Supplemental Digital Content is available in the text.

Reconstruction of total circumferential pharyngeal defects following caustic or stenosant lesions of the pharynx present major challenges with respect to minimizing surgical morbidity and restoring functional deficits. With recent advances in microvascular free tissue transfer, the options for pharyngeal reconstruction have multiplied in order to maximize swallowing and voice. There is long experience in the reconstruction of the pharynx and the cervical esophagus in oncological patients after total pharyngolaryngectomy, but there are not many publications concerning circumferential pharyngeal reconstruction preserving the larynx. Here, we discuss 2 new techniques for total circumferential pharyngeal reconstruction respecting swallowing and voice by means of extra-anatomical bypasses (visceral or fasciocutaneous), upholding the larynx in its original placement.

Original treatment for ischaemic stenosis of colon interposition: Report of two cases

INTRODUCTION

The treatment of ischaemic stenosis of colon interposition for oesophageal replacement remains poorly defined.

CASE REPORT

We report two cases of patients operated for ischaemic stenosis of the cervical extremity of the colon interposition for caustic stenosis of the oesophagus. Treatment consisted of resection of the stenosis with creation of a new cervical anastomosis after complete release of the colon graft via a neck and upper midline incision in one patient and a new ileocolic graft exclusively replacing the stenotic segment of the oesophagoplasty in the second patient.

DISCUSSION

These two cases illustrate the complex treatment modalities required for this complication.

CONCLUSION

The treatment of choice of ischaemic stenosis of colon interposition is resection with creation of a new anastomosis, but repeat graft may sometimes be the only available treatment option.

Cell reactions in gastric tube and colon transplants in stenoses of esophageal anastomosis

We studied morphological and cell characteristics of stenosis of esophagogastric and esophagocolonic anastomosis. It was demonstrated that sclerogenesis in the gastric transplants is associated with hypertrophy of leiomyocytes, hyperelastosis foci, degenerative and atrophic modifications of the glands, and foveolar cell hypersecretion. In colonic transplant, collagen synthesis predominates in the esophageal anastomosis and can be associated with proliferation of blood capillaries; hyperplastic reactions of leiomyocytes and elastic fibers are minor, colonocytes exhibit high secretory activity. Differences in the cell reactions of the transplants reflect complex character of the formation of esophageal anastomosis stenosis.

[Late complications of a skin oesophagoplasty realized 45 years before: an historical case]

We report the case of a patient operated for the late complications of a skin-lined tube reconstruction of the esophagus performed 45 years ago. We recall the historical interest of this method for total esophageal reconstruction and emphasize the fact that it can still be a solution of last resort when intestinal tubes are no longer available.