P1.017. Innovative Applications of the Internal Mammary Artery in Supercharged Colon Replacement

Abstract

Abstract Topic Benign Disease: Esophageal Surgery Background Esophageal reconstruction poses significant challenges, particularly when traditional methods are not viable. This study explores innovative applications of the internal mammary artery (IMA) in supercharged colon replacement for esophageal reconstruction. Methods Analyzing nearly 1,000 esophageal resections performed between 1995 and October 2024 in Surgical Department, University of Pecs. We highlight the use of microsurgical techniques in 49 cases, specifically employing 38 free jejunal grafts and 11 supercharged colon replacements. Results During 11 "supercharged" colon replacements, the internal mammary vessels were utilized as receiving vessels in 7 cases, comprising 2 delayed primary and 5 secondary reconstructions, with patients 42 years old in average. The procedures involved ileocolon replacement, and the internal mammary artery and vein were accessed through a previously unreported left intercostal approach with only minimal or without rib resection due to unsuitable cervical vessels. While one patient experienced an anastomotic failure leading to sepsis and another required graft removal due to thrombosis, five patients healed without complications and achieved a good swallowing function Conclusion The purpose of the study is to verify the advantages of supercharged colon grafts in complicated esophageal reconstructions, which, in addition to reducing reflux, provide safe blood supply and can be easily applied even in the case of the ileocolon replacement. Moreover, the implementation of the supercharge technique significantly mitigates risks associated with ischemia and delayed motility. This research underscores the necessity of interdisciplinary collaboration between general and plastic surgeons skilled in microsurgery to optimize esophageal reconstruction outcomes.Ultimately, supercharged ileocolon replacement emerges as a viable and effective alternative in complex surgical scenarios where conventional methods fail.