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Surgical management of failed colon interposition

^a Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Blake 1570, Boston, MA, United States
^b Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States

Received 16 September 2007; received in revised form 31 March 2008; accepted 2 April 2008.

^_* Corresponding author. Tel.: +1 617 726 6826; fax: +1 617 7267667. (Email: pdedelva{at}partners.org).

Background: Complications following colon interposition may be acute or chronic and often devastating. Creative strategies are needed to preserve the conduit or develop alternatives when the conduit cannot be salvaged. Methods: The records of patients undergoing revision surgery of colon interposition between 1965 and 2005 were reviewed. Results: Thirty-five patients underwent 48 operative revisions. Nineteen patients underwent one operation, nine required multiple operations to manage one problem and seven developed more than one distinct problem requiring several operative interventions. The most common indications for revision surgery were redundancy (n = 13), stricture (n = 11), and loss of intestinal continuity (n = 8). The most common revisional operations were anastomotic revision (n = 13), segmental colonic resection (n = 6), and stricturoplasty (n = 4). Swallowing function was restored in 32 of 35 patients. Loss of intestinal continuity was successfully reversed in six of seven patients. There were no intraoperative deaths. Four patients required re-operation after a failed revision at our institution. Swallowing was restored in three of four patients. Conclusions: Complications that develop after colon bypass present major challenges for surgeons to maintain swallowing and quality of life. We present successful strategies to manage these devastating complications. It is the largest report dealing with a wide variety of complications of colon bypass.

Key Words: Esophagectomy • Esophageal replacement • Colon interposition

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