Colon Interposition In The Treatment Of Esophageal Carcinoma After Gastrectomy And An Evaluation Of Motor Activity In Interposed Colon

First Part: [ Objective ] The purpose of this paper is to report our experience with colon interposition in the treatment of postgastrectomy esophageal carcinoma. [Methods] In 26 cases of postgastrectomy esophageal carcinoma, the various operative approachs, complications, results and postoperative alimentary functions were reviewed. [Results] One patient died of acute myocardial infarction on 8 days after operation. One patient sustained colon graft necrosis in cervical part. Four patients had cervical anastomotic leaks.Colon interposition was placed in an isoperistaltic fashion in 18 patients. The overall l-and2-year survival rates were 77.8% and 44.5% respectively. Colon interposition was placed in an antiperistaltic fashion in 8. The overall 1-and 2-year survival rates were 62.5% and 37.5% respectively. Compared by alimentary function graded by clinical gastrointestinal symptoms, colon interposition placed in an isoperistaltic fashion was better than that placed in an antiperistaltic fashion. [Conclusions] Shortening of transverse colon and narrowing of colic arteries and its branches after gastrectomy were related to a serious degree of adhesions in the abdominal cavity and gastrojejunal anastomosis after gastrectomy.Second Part : [Objective] The purpose of this paper is to evaluate motor activity of interposed colon and to study postoperational gastrointestinal function between the isoperistaltic and antiperistaltic segment. [Methods] In 10 cases of colon replacement of esophagus,manometric studies were carried out when the colon grafts subjected to the following stimuli :quiescent states,dry swallowing,swallowing of 30ml distilled water.Thegastrointestinal function was scored 3-12 months after operation. [ Result ] The constractions of interposed colon were divided into four types : HAPCs, LAPCs, HANPCs, LANPCs. The migrating constraction of were induced from esophagus to colon segment by wet swallowing. The motor activity of the interposed colon graft after wet swallowing was significantly higher that after dry swallowing. The direction of the peristaltic sequence was duced to isoperistaltic or antiperistaltic colon interposition. From a alimentary functional point of view, colon interposition placed in an isoperistaltic fashion was better than that placed in an antiperistaltic fashion. [Conclusion] Directly stimulation by fluid is an important factor in promoting motor activity in interposed colon grafts. Progressive waves in the interposed segment helping to propel ingested food and drink into stomach and to clear the gastric juice if reflux from the stomach occurred. Antiperistaltic motility is a risk factor for the development of occult many discomforts during the early postoperative period, colon interposition should been tried best to place in an isoperistaltic fashion.