Colon interposition esophagectomy

A defect was placed between the ends of the esophagus using the colon. The function of the esophageal sphincter can be preserved via the intrathoracic approach. If the sternal pathway is passed, the colon can only be anastomosed to the stomach, which can cause reflux colitis, leading to colonic ulceration. Treatment of diseases: congenital esophageal atresia Indication Inter-colon replacement esophagectomy is applicable to: 1. The esophagus is locked, and the distance between the two ends of the esophagus is long. 2. The esophageal atresia failed and could not be repaired. Contraindications 1. The general condition is poor and cannot tolerate major surgery. 2. Aspiration pneumonia is severe and requires surgery before surgery. Preoperative preparation 1. Type I esophageal atresia, the upper end of the esophagus can be placed in the left neck outside the stoma, and a small incision in the upper abdomen for a simple gastrostomy for tube feeding. While waiting for the surgery, the mouth can be trained to feed the food to maintain swallowing reflexes, and the stoma is placed in a small bag to receive the swallow. 2. Preoperative 3d intestinal preparation, with sulfamethoxazole and neomycin, systemic metronidazole (metidazole), can not be used for cleansing enema. A small slag diet was administered through a gastrostomy tube. Surgical procedure Incision After the left 8th intercostal space, the chest and abdomen combined incision, cut the rib arch to the upper part of the abdomen, and cut the diaphragm without cutting the esophageal hiatus. Free colon The spleen and kidney ligaments were cut, and the spleen, pancreas and stomach were pulled to the medial side. Cut the stomach ligament and present the colon. The blind end of the mediastinal pleura free esophagus was cut and pulled with a gauze to facilitate anastomosis. 3. Prepare the pedicled colon If the middle cerebral artery is ligated and the left colon artery is used as the intestinal vascular blood vessel, the transverse colon can be used for the peristaltic anastomosis. Before the blood vessel is cut off, the blood flow of the intestine is observed. The distance from the neck to the lower esophagus was measured before cutting the colon. Due to the variation of the colonic artery, it is sometimes necessary to ligature and cut the ileal artery and the right colon of the colon with the middle cerebral artery as a nutrient vessel, and the right hemi-colonial colon and the ascending colon for a peristaltic anastomosis. For example, if the left colon of the colon is ligated and the middle cerebral artery is used as a nutrient vessel, the left semi-transverse colon and part of the descending colon can be used for retrograde peristalsis. The two cut ends of the colon are protected with a rubber sleeve to avoid contaminating the wound. 4. Place the colon The cut colon was end-to-end anastomosed by two-layer intermittent suture. A small incision is made through the colon and its vascular pedicle on the right side of the lame and esophageal hiatus. The colon is delivered to the neck through the thoracic apex tunnel behind the hilum. The colon is located in the anterior aspect of the subclavian artery to prevent damage to the subclavian vein. And oppress the trachea. Note that the colon pedicle can pass through the displaced spleen and the space in front of the kidney without tension, so as not to affect the blood supply. If the distal end of the colon is found to be too long, it can be partially removed. 5. Distal esophagus colon anastomosis The distal end of the esophagus was cut open to the colon for a layer of intermittent anastomosis. 6. suture the chest and abdomen The diaphragmatic suture is sutured, the chest and abdomen wall incision is layered and sutured, the rib arch is sutured with thick silk thread, the thoracic cavity is built-in drainage tube, and the chest wall is poked out. The original stomach stoma is placed in the stoma tube and another silicone is placed through the fistula. Tube to the duodenum for postoperative feeding. 7. neck anastomosis The original neck esophagus stoma is freed, the surrounding scar is removed, and the esophagus and the colon are sutured intermittently without tension. Insert the nasogastric tube into the colon segment through the anastomosis for postoperative decompression. If there is doubt about the blood supply to the colon at this time, the anastomosis can be performed after 1 to 2 weeks, and the colonic end is fixed to the subcutaneous by intermittent suture. The tissue surrounding the colon and the thoracic crest is fixed by a thin wire to close the thoracic channel, so as to prevent secretions from flowing into the chest through the channel after anastomosis. complication 1. Anastomotic fistula: neck anastomotic fistula and intestinal anastomotic fistula, see the previous section. 2. The voice is hoarse: caused by damage to the recurrent laryngeal nerve. 3. Intestinal obstruction: caused by intestinal adhesion after intra-abdominal surgery, sick children with paroxysmal abdominal pain, abdominal distension. X-ray examination has multiple gas-liquid surfaces in the abdomen. First use conservative treatment, such as invalid and open laparotomy.