The Experts below are selected from a list of 249 Experts worldwide ranked by ideXlab platform
Tom R Demeester - One of the best experts on this subject based on the ideXlab platform.
-
long term quality of life and alimentary satisfaction after esophagectomy with Colon Interposition
The Annals of Thoracic Surgery, 2014Co-Authors: Christina L Greene, Steven R Demeester, Florian Augustin, Stephanie G Worrell, Daniel S Oh, Jeffrey A Hagen, Tom R DemeesterAbstract:BACKGROUND: The long-term outcome after Colon Interposition for esophageal reconstruction is not well documented. Our objective was to assess quality of life and alimentary satisfaction 10 or more years after Colon Interposition. METHODS: Patients who had an esophagectomy that was reconstructed using a Colon Interposition before April 2003 were identified. Symptoms, alimentary satisfaction, and quality of life were assessed by telephone interview and questionnaires. RESULTS: We identified 79 surviving patients, and follow-up was obtained in 63 (80%). The indication for esophagectomy was cancer in 45 patients and benign disease in 18. Vagal-sparing esophagectomy was performed in 48% of patients, en bloc in 44%, and transhiatal in 8%. Median follow-up was 13 years (range, 10 to 38 years). The median Gastrointestinal Quality of Life Index score was 3 of 4 and results from the RAND 36-Item Short Form Health Survey (RAND Corp, Santa Monica, CA) were at or above the published normal means in all categories. Most patients were free of dysphagia (89%), regurgitation (84%), and heartburn (84%). The most common postprandial symptom was early satiety (40%). The body mass index was within normal reference ranges in 90% of patients. Follow-up esophagogastroduodenoscopy in 30 patients at a median of 6 years showed no Barrett's metaplasia in the residual esophagus. Seven patients had a reoperation for Colon redundancy. CONCLUSIONS: Long-term alimentary satisfaction and quality of life were excellent after Colon Interposition. Most patients were free of dysphagia and few needed revision for redundancy. These results should encourage the use of a Colon Interposition in patients expected to survive long-term after esophagectomy.
-
arterial anatomic considerations in Colon Interposition for esophageal replacement
Archives of Surgery, 1995Co-Authors: Jeffrey H Peters, Jeffrey W Kronson, Michael Katz, Tom R DemeesterAbstract:Background: Little has been written regarding the arterial anatomy predictive of success following esophagectomy and Colon Interposition. Design: Retrospective review. Setting: University teaching hospital. Patients: Twenty-five patients undergoing planned left Colon Interposition. Intervention: Colon Interposition was performed via an isoperistaltic left Colon graft based on the ascending branch of the left colic artery. Main Outcome Measures: Five angiographic features were considered important to successful use of the left Colon: (1) a patent inferior mesenteric artery, (2) a visible ascending branch of the left colic artery, (3) a well-defined anastomosis between the middle colic and left colic systems, (4) a single middle colic trunk prior to its division into right and left branches, and (5) a separate origin of the right colic artery. Venous drainage via a patent marginal vein, inferior mesenteric vein, and superior hemorrhoidal veins was preserved in all patients. Results: Left Colon Interposition could be performed in 21 (84%) of 25 patients. Eighty percent of the patients (20/25) had at least four of the five criteria thought necessary for optimal graft perfusion. Three or fewer criteria were present in five patients, three of whom underwent gastric Interposition. The inferior mesenteric artery was patent in all patients except one who required a right Colon Interposition. Ninety-two percent (23/25) demonstrated an adequate ascending left colic artery. The superior-inferior mesenteric artery anastomosis was seen in 52% (13/25). A single-trunked middle colic artery was present 80% (20/25) of the time. A single incidence of graft necrosis occurred secondary to venous insufficiency. Ninety-six percent of patients (24/25) were able to swallow without difficulty at the time of discharge from the hospital. Conclusions: Replacement of the esophagus with Colon can be successful in over 80% of patients screened by angiographic criteria. Patients with an occluded or stenotic inferior mesenteric artery or variant middle colic arterial anatomy should undergo an alternate reconstruction. (Arch Surg. 1995;130:858-863)
-
esophageal resection with Colon Interposition for end stage achalasia
Archives of Surgery, 1995Co-Authors: Jeffrey H Peters, Werner K H Kauer, Peter F Crookes, Adrian P Ireland, Cedric G Bremner, Tom R DemeesterAbstract:Objective: To review the potential benefits of esophageal resection with Colon Interposition in patients with achalasia. Design: Retrospective review. Setting: University-based tertiary care center. Patients: Nineteen patients (13 men, six women; median age, 44 years; age range, 26 to 77 years) with achalasia and recurrent or persistent dysphagia despite a variety of previous treatments. Interventions: Esophageal resection and replacement with Colon Interposition. Main Outcome Measures: Mortality and morbidity of the procedure, symptomatic outcome, nutritional impact, ability to ingest a meal, and overall patient satisfaction. Results: Follow-up results were available in 15 patients. The procedure accounted for no deaths and complications in four patients. Outcome assessment was done at a median of 6 years (range, 1 to 14 years) after resection. Overall, the symptomatic outcome was excellent to good in 12 patients. Eleven of the 15 patients gained weight (median weight loss, 6.3 kg) after the procedure. Thirteen patients were able to eat three meals daily; seven had the capacity to eat a steak dinner; five, an airline meal; and three, a snack. Nine of the 15 patients enjoyed an unrestricted diet. The speed of ingesting a meal was reduced in that most (11 of 15) were the last to finish when eating in a group. Fourteen of the 15 believed that the operation had cured or improved their preoperative symptoms, and a similar percentage were satisfied with the overall outcome of surgery. Most patients (12 of 15) would have the operation again. Conclusions: Esophageal replacement for end-stage achalasia can be accomplished with safety and marked improvement of preoperative symptoms. Despite multiple previous therapeutic failures, normal alimentation was restored in the majority of patients, with 93% judging the operation to be highly beneficial, improving their quality of life. Based on this success, guidelines for resection in end-stage achalasia are established. (Arch Surg. 1995;130:632-637)
Douglas J Mathisen - One of the best experts on this subject based on the ideXlab platform.
-
surgical management of failed Colon Interposition
European Journal of Cardio-Thoracic Surgery, 2008Co-Authors: Pierre E De Delva, John C Wain, Cameron D Wright, Christopher R Morse, W G Austen, Henning A Gaissert, Michael Lanuti, Douglas J MathisenAbstract: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 mostcommon 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 sevenpatients.Therewerenointraoperativedeaths.Fourpatientsrequiredre-operationaftera failedrevisionatourinstitution.Swallowingwas 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. # 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
-
long segment Colon Interposition for acquired esophageal disease
The Annals of Thoracic Surgery, 1999Co-Authors: John C Wain, Cameron D Wright, Ashby C Moncure, Earle W Wilkins, Hermes C Grillo, Douglas J MathisenAbstract:Abstract Background . Long-segment Colon Interposition has been used for esophageal replacement for acquired esophageal disease. The indications for use, morbidity, and functional results of these conduits have been debated. Methods . We reviewed the medical records, office visits, and operative reports of patients undergoing long Colon Interposition for acquired esophageal disease at our institution from 1956 to 1997. Results . Long Colon Interposition was performed in 52 patients for caustic injury (n = 20), gastroesophageal disease (n = 16), previous irradiation (n = 8), primary motility disorders (n = 4), and acquired absence of the esophagus (n = 4). From 1976 to 1997, acquired diseases accounted for 62% of long Colon Interposition. The left Colon was used in 46 patients and the right Colon in 6. The in-hospital mortality rate was 4%. Early complications included graft ischemia in 5 patients, anastomotic leak in 3, and small bowel obstruction in 1. Late complications included anastomotic stenosis requiring dilation in 26 patients, with 2 requiring surgical revision, and bile reflux requiring surgical diversion in 1 patient. Swallowing function was excellent in 24% of patients, good in 66%, and poor in 10%. Conclusions . Long Colon Interposition can be performed safely, with acceptable long-term functional results in patients with acquired esophageal disease.
Minhsiung Huang - One of the best experts on this subject based on the ideXlab platform.
-
short segment Colon Interposition for end stage achalasia
The Annals of Thoracic Surgery, 2003Co-Authors: Chienying Wang, Chihcheng Hsieh, Minhsiung HuangAbstract:Abstract Background The reoperative procedures for achalasia vary. Repeat esophagomyotomy with or without antireflux procedure and esophageal resection of varying extent with reconstruction using stomach, jejunum, or Colon have been reported. In this series, we have retrospectively reviewed our experience and reported the results with limited distal esophagectomy and short-Colon Interposition in the treatment of patients with recurrent symptoms of achalasia after prior failed esophagomyotomy. Methods Nine consecutive patients (5 men, 4 women; 27 to 74 years of age; mean, 52 years) with recurrent symptoms of achalasia and at least one failed prior esophagomyotomy underwent gastric cardiectomy, distal esophagectomy, and replacement with an at least 30-cm short-Colon Interposition through a left thoracoabdominal approach. Morbidity of the procedure and the length of hospital stay were recorded. The symptomatic evaluation, ability to have a meal, and overall patient satisfaction after the operations were assessed. Results Follow-up results were available in 8 patients. One patient had intestinal strangulation with graft failure 3 days after operation. Takedown of the graft and end-to-side esophagogastrostomy were successful. There was no mortality. Outcome assessment was completed at a median of 6 years (range, 1 to 12 years). Overall patient satisfaction was good in 6 patients, and fair and worse in 1 patient each. Most of the patients could have regular meals. Two patients had intermittent abdominal fullness after meals. Six of these 8 patients would have the operation again. Conclusions Limited distal esophagectomy with short-Colon Interposition through a left thoracoabdominal approach is a safe and feasible alternative to near total esophagectomy in patients with achalasia who have prior failed esophagomyotomy. Improved alimentary function was observed in most of the patients after operation, which resulted in a better quality of life.
Jeffrey H Peters - One of the best experts on this subject based on the ideXlab platform.
-
arterial anatomic considerations in Colon Interposition for esophageal replacement
Archives of Surgery, 1995Co-Authors: Jeffrey H Peters, Jeffrey W Kronson, Michael Katz, Tom R DemeesterAbstract:Background: Little has been written regarding the arterial anatomy predictive of success following esophagectomy and Colon Interposition. Design: Retrospective review. Setting: University teaching hospital. Patients: Twenty-five patients undergoing planned left Colon Interposition. Intervention: Colon Interposition was performed via an isoperistaltic left Colon graft based on the ascending branch of the left colic artery. Main Outcome Measures: Five angiographic features were considered important to successful use of the left Colon: (1) a patent inferior mesenteric artery, (2) a visible ascending branch of the left colic artery, (3) a well-defined anastomosis between the middle colic and left colic systems, (4) a single middle colic trunk prior to its division into right and left branches, and (5) a separate origin of the right colic artery. Venous drainage via a patent marginal vein, inferior mesenteric vein, and superior hemorrhoidal veins was preserved in all patients. Results: Left Colon Interposition could be performed in 21 (84%) of 25 patients. Eighty percent of the patients (20/25) had at least four of the five criteria thought necessary for optimal graft perfusion. Three or fewer criteria were present in five patients, three of whom underwent gastric Interposition. The inferior mesenteric artery was patent in all patients except one who required a right Colon Interposition. Ninety-two percent (23/25) demonstrated an adequate ascending left colic artery. The superior-inferior mesenteric artery anastomosis was seen in 52% (13/25). A single-trunked middle colic artery was present 80% (20/25) of the time. A single incidence of graft necrosis occurred secondary to venous insufficiency. Ninety-six percent of patients (24/25) were able to swallow without difficulty at the time of discharge from the hospital. Conclusions: Replacement of the esophagus with Colon can be successful in over 80% of patients screened by angiographic criteria. Patients with an occluded or stenotic inferior mesenteric artery or variant middle colic arterial anatomy should undergo an alternate reconstruction. (Arch Surg. 1995;130:858-863)
-
esophageal resection with Colon Interposition for end stage achalasia
Archives of Surgery, 1995Co-Authors: Jeffrey H Peters, Werner K H Kauer, Peter F Crookes, Adrian P Ireland, Cedric G Bremner, Tom R DemeesterAbstract:Objective: To review the potential benefits of esophageal resection with Colon Interposition in patients with achalasia. Design: Retrospective review. Setting: University-based tertiary care center. Patients: Nineteen patients (13 men, six women; median age, 44 years; age range, 26 to 77 years) with achalasia and recurrent or persistent dysphagia despite a variety of previous treatments. Interventions: Esophageal resection and replacement with Colon Interposition. Main Outcome Measures: Mortality and morbidity of the procedure, symptomatic outcome, nutritional impact, ability to ingest a meal, and overall patient satisfaction. Results: Follow-up results were available in 15 patients. The procedure accounted for no deaths and complications in four patients. Outcome assessment was done at a median of 6 years (range, 1 to 14 years) after resection. Overall, the symptomatic outcome was excellent to good in 12 patients. Eleven of the 15 patients gained weight (median weight loss, 6.3 kg) after the procedure. Thirteen patients were able to eat three meals daily; seven had the capacity to eat a steak dinner; five, an airline meal; and three, a snack. Nine of the 15 patients enjoyed an unrestricted diet. The speed of ingesting a meal was reduced in that most (11 of 15) were the last to finish when eating in a group. Fourteen of the 15 believed that the operation had cured or improved their preoperative symptoms, and a similar percentage were satisfied with the overall outcome of surgery. Most patients (12 of 15) would have the operation again. Conclusions: Esophageal replacement for end-stage achalasia can be accomplished with safety and marked improvement of preoperative symptoms. Despite multiple previous therapeutic failures, normal alimentation was restored in the majority of patients, with 93% judging the operation to be highly beneficial, improving their quality of life. Based on this success, guidelines for resection in end-stage achalasia are established. (Arch Surg. 1995;130:632-637)
Junichi Ogawa - One of the best experts on this subject based on the ideXlab platform.
-
surgical outcome of Colon Interposition by the posterior mediastinal route for thoracic esophageal cancer
The Annals of Thoracic Surgery, 2007Co-Authors: Satoru Motoyama, Michihiko Kitamura, Reijiro Saito, Kiyotomi Maruyama, Yusuke Sato, Kaori Hayashi, Hajime Saito, Yoshihiro Minamiya, Junichi OgawaAbstract:Background For thoracic esophageal cancer patients with a history of gastrectomy, esophageal reconstruction using segments of Colon was often accomplished using the anterior mediastinal route to avoid fatal complications related to Colon necrosis. Our aim was to review our experience with reconstruction by the posterior mediastinal route and assess the surgical outcomes. Methods Between 1989 and August 2006, 34 esophageal cancer patients at Akita University Hospital underwent esophageal reconstruction accomplished by Colon Interposition by the posterior mediastinal route. Data from these patients were reviewed. Results Colon conduits consisted of left Colon segments in 4 patients and right Colon segments in 30. The grafts were supplied with blood by the left Colonic artery in 13 patients, the middle Colonic artery in 20, and the right Colonic artery in 1. The esophagocolic (pharyngocolic) anastomosis was located in the neck in 33 patients (97%) and in the thorax in 1. No patient died during the initial hospital stay. There were no instances of Colon necrosis. An anastomotic fistula occurred in 3 patients (9%). Proximal anastomotic strictures occurred in 2 patients (6%). No late graft redundancies resulting in significant dysphagia occurred. Reductions in body weight did not differ from those seen when the gastric tube was used for reconstruction, and alimentary function was good after surgery. The 1-, 2-, 3-, and 5-year survival rates were 66%, 52%, 48%, and 48%, respectively. Conclusions Colon Interposition by the posterior mediastinal route provides a good outcome and is considered the route of first choice.