Esophagus conduits

Conduits of the  esophagus after esophagus resection



Interposition of the left colon is the  most popular

Ligation of the middle colic artery, and transection of the colon at the right flexure and somewhere between the left flexure and the midportion of the descending colon

 Preference for left colic interposition

a) Based on vascular  anatomy and its natural variation in the colon.

---Marginal artery  between the ileocolic and right colic vessels are absent in up to 70% of patients

--- whereas the collaterals between the left and right colic artery are mostly sufficient.

In the left colon, the marginal venous anastomoses are excellent, but ileocolic venous collaterals are insufficient in 20% to 30% of patients.

Left colon vs right colon

ischemia rate left colon 5%

Right colon approaches 10%

Reasons of ischemia

Damage to the ascending branch of the left colic artery or

marginal arteries and veins at this site.

Comparision of THE and TTE

  1. Respiratory problem - The overall incidence of pneumonia was 25%, and it was not appreciably different between the two techniques. 
  2. Anastomotic leak rate (16% transhiatal vs. 10% Ivor Lewis), stricture (28% transhiatal vs. 16% Ivor Lewis), and recurrent nerve injury (11% transhiatal vs. 5% Ivor Lewis)