Colon Interposition to Replace an Absent Esophagus is the Procedure of Choice in Low-Income Countries

1. Introduction

2. Abdominal Incision and Access to the Abdominal Cavity

1. Lysis of Adhesions

3. Omentectomy

4. Colon Mobilization Including the Splenic Flexure

5. Release of Attachments Around the Ligament of Treitz

6. Determination of Blood Supply and Length of Colon

1. Compare the Middle Colic and Left Colic Vascular Supply
2. Marginal Artery is Preserved

7. Construction of Colonic Interposition Graft

8. Stomach Mobilization

9. Excision and Repair of Gastrostomy Site

10. Transposition of Colon Posterior to Stomach

11. Cervical Incision and Mobilization of Esophagostomy

12. Formation of Tunnel

13. Passing of Colon Through Tunnel

14. Cervical Esophagocolonic Anastomosis

15. Distal Cologastric Anastomosis

16. Reconstruction of Colonic Continuity via a Right to Distal Left Colocolonic Anastomosis

17. Closure of Mesentery

18. Gastrostomy Creation

19. Abdominal Closure

1. Peritoneum
2. Anterior Fascia

20. Cervical Incision Closure

1. Place Cervical Drain and Reapproximate Muscles
2. Skin Excision
3. Reapproximate Platysma
4. Secure Penrose Drain to Skin

21. Skin Closure

1. Secure G Tube to Skin

22. Post-op Remarks