Supercharged Colonic Interposition for Total Oesophageal Reconstruction: Technical Refinements, Perioperative Protocol, and Functional Outcomes

Sarut Chaisrisawadisuk; Pornchanit  Karanthakarn; Sirin  Apichonbancha; Nutcha  Yodrabum; Jirawat  Swangsri

doi:10.33192/smj.v78i10.284353

Authors

Sarut Chaisrisawadisuk, M.D., FRCST Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Pornchanit Karanthakarn, M.D., FRCST Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Sirin Apichonbancha, M.D. Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Nutcha Yodrabum, M.D., FRCST Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Jirawat Swangsri, M.D., Ph.D., FRCST Division of Minimal Invasive Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33192/smj.v78i10.284353

Keywords:

oesophageal reconstruction, colonic interposition, supercharged flap, microvascular augmentation, visceral reconstruction, swallowing function

Abstract

Objective: We report a 10-year experience with supercharged colonic interposition (CI) for total oesophageal reconstruction, focusing on technical refinements and functional outcomes.

Materials and Methods: A retrospective review of patients undergoing total oesophageal reconstruction (2014–2024) was conducted. A modified, supercharged CI was performed using a longer terminal ileal segment of 20–30 cm. Conduits were routed subcutaneously, and arterial supercharging—usually to the transverse cervical artery—was performed selectively. When congestion persisted, venous superdrainage was additionally implemented. Outcomes were compared with a contemporaneous gastric pull-up (GPU) cohort.

Results: Twenty-one patients underwent reconstruction (11 CI, 10 GPU). No graft failures occurred after supercharged CI. Anastomotic leakage occurred in 18.2% of CI and 10.0% of GPU patients (P=1.00) and was managed without conduit loss. Stricture was more frequent after CI (36.4% vs. 10.0%, P=0.31) and was successfully treated endoscopically. At a median follow-up of 21 months, all CI patients tolerated oral intake (45.5% solid, 45.5% soft diet); feeding tube dependence was 27.3% after CI vs. 60.0% after GPU (P=0.19).

Conclusions: Supercharged colonic interposition was associated with preserved graft viability and satisfactory functional recovery in patients requiring complex total oesophageal reconstruction. A defined selection algorithm, standardised technique, subcutaneous routing, and structured perioperative care offer a reproducible framework for complex oesophageal reconstruction when gastric pull-up is not feasible.

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