Conduits for esophageal replacement: alternatives


  • Prabhat B. Nichkaode Department of Surgery, Chandulal Chandrakar Memorial Medical College, Kachandur, Durg, Chhattisgarh, India
  • Tarun Naik Department of Surgery, Chandulal Chandrakar Memorial Medical College, Kachandur, Durg, Chhattisgarh, India
  • Anurag Sharma Junior resident (DNB), JLN Hospital and Research Centre, Bhilai, Chhattisgarh, India



Colon, Conduit, Interposition, Jejunum, Oesophagectomy, Stomach


Background: Native esophageal replacement after esophageal resection is a problem that has challenged the surgeons over a century. Conduit must be long enough to bridge between cervical esophagus and abdomen. It must have reliable vascular supply, so that it can perform its function of deglutition. Stomach, colon and jejunum all these are used since long. However, there are times when the stomach is unavailable for use as a conduit. It is in these instances that an esophageal surgeon must have an alternative conduit in their armamentarium. Present study is aimed to discuss technical aspects of stomach, colonic, interposition in 32 cases of benign and malignant pathology, we review recent literature with a focus on outcomes, advantages and disadvantages of all options.

Methods: A retrospective study of 32 cases between 2009 to 2016 at teaching institute in central India. 32 cases of benign and malignant esophageal disease needing esophageal resection and replacement. The record of each patient was reviewed for age, gender, indication for esophageal resection, type of operation, indication for selection of conduit, morbidity and mortality. The patient’s gastrointestinal symptoms were graded as excellent, good, fair or poor. Survival was estimated by the Kaplan-Meier method using the date of operation as the starting point.

Results: Study includes 24 males and 8 females, 25 cases cancer esophagus with 6 patients caustic stricture, 1 patient had radiation stricture. Gastric conduit was used in 29 patients while 3 patients had colonic interposition. No complications noted in colonic group, while cervical anastomotic leak along with cardiovascular and respiratory complications noted in 6 patients. Gastric replacement was less time consuming than colonic interposition. There was hospital mortality of 4 patients. There is no difference in survival of these patients whether you use gastric or colonic conduit.

Conclusions: Clinical decision making in the treatment of esophageal cancer consists of balancing the risks of a particular treatment against potential benefits gained in survival and quality of life. The choice of conduit for reconstruction may have significant impact on the quality of life. Stomach is the most commonly used organ for replacement but when it is not available then colon can safely be used as an esophageal replacement.


Shackelford’s, Surgery of alimentary tract, 6th Edition, volume 1; 2007:8-11.

Yasuda T, Shiozaki H, esophageal reconstruction with colonic tissue. Surg Today. 2011;41:745-53.

DeMeester SR. Colonic Interposition for benign disease. Oper Tech Thorac Cardiovasc Surg. 2006;11(3):232-49.

Boukerrouche A. Isoperstaltic left colic graft interposition via a retrsternal approach for esophageal reconstruction in patients with caustic stricture; mortality, morbidity and functional results. Surg Today. 2014;44:827-33.

Bartels H, Stein HJ, Siewert JR. Preoperative risk analysis and postoperative mortality of oesophagectomy for resectable oesophageal cancer. Br J Surg. 1998;85:840-8.

Beahrs OH, Henson DE, Hutter RVP, Kennedy BJ. American joint committee on cancer. Manual for staging of cancer. Philadelphia: JB Lippincot; 1992:57-61.

Strauss DC, Forshaw MJ, Tandon RC, Mason RC. Surgical management of colonic redundancy following esophageal replacement. Dis Esophagus. 2008;21(3).

Reslinger V, Tranchart H, D'annunzio E, Poghosyan T, Quero L, Munoz‐Bongrand N, et al. Esophageal reconstruction by colon interposition after esophagectomy for cancer analysis of current indications, operative outcomes, and long‐term survival. J Surg Oncol. 2016;113(2):159-64.

Korst RJ, Sukumar M, Burt ME. Atraumatic gastric transposition after transhital esophagectomy. Ann Thorac Surg. 1997;64:867-9.

Rice TW. Colon replacement. In: Pearson FG, Deslauriers J, Ginsberg RJ, et al, eds. Esophageal surgery. New York: Churchill Livingstone; 1995: 761-74.

Peters JH, Kronson JW, Katz M, DeMeester TR. Arterial anatomic considerations in colon interposition for esophageal replacement. Arch Surg 1995;130:858-63.

Schardey HM, Joosten U, Finke U, Staubach KH, Schauer R, Heiss A, et al. The prevention of anastomotic leakage after total gastrectomy with local decontamination. A prospective, randomized, double-blind, placebo-controlled multicenter trial. Ann Surg. 1997;225(2):172-80.

DeMeester TR, Johansson KE, Franze IN, Eypasch E, Lu CT, McGILL JE, et al. Indications, surgical technique, and long-term functional results of colon interposition or bypass. Ann Surg. 1988;208(4):460-74.

Bozzetti F, Bonfanti G, Castellani R, Maffioli L, Rubino A, Diazzi G, et al. Comparing reconstruction with Roux-en-Y to a pouch following total gastrectomy. J Am Coll Surg. 1996;183(3):243-8.

Nakane Y, Okumura S, Akehira K, Okamura S, Boku T, Okusa T, et al. Jejunal pouch reconstruction after total gastrectomy for cancer. A randomized controlled trial. Ann Surg. 1995;222(1):27-35.

Sobin LH, Wittekind C. International Union Against Cancer UICC- International Union against cancer, ed,TNM Classification of Malignant tumors. Baltimore MD, wiley liss, 7th Edition; 2009:63-66.

Kolh P, Honore P, Degauque C, Gielen J, Gerard P, Jacquet N. Early stage results after oesophageal resection for malignancy: colon interposition versus gastric pull-up. Eur J Cardiothorac Surg. 2000;18:293-300.






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