Peristalsis in an interposed colonic segment immediately following total oesophagogastrectomy

Background: The motility pattern of colon used for oesophageal replacement in an oesophagogastrectomy is thought to be altered following interposition. Whether this is the result of adaptation or the removal of motor control mechanisms is unknown. Motility patterns of the interposed colon during the immediate postoperative period have not been previously studied. Methods: A patient who had an oesophageal adenocarcinoma and an unhealed gastric ulcer, underwent total gastrectomy and oesophagectomy. A colonic segment oriented isoperistaltically was used for oesophageal replacement. During the surgery, a customized 10 channel motility catheter was introduced transnasally into the colonic segment, and 24 h after surgery measurement of motor activity was undertaken using a perfused manometric system.

Results: Peristaltic contractions were observed with a mean contraction amplitude of 39.6 mmHg in the proximal channel, 90.3 mmHg in the distal channel and a mean propagation velocity of 0.51 cm/s.

Conclusions: Peristaltic colonic contractions continue to occur in the early postoperative period in the colonic segment used to replace the oesophagus. In view of this, colon replacing the oesophagus should always be arranged in an isoperistaltic fashion.