From the Guidelines
When a patient with EA-TEF colonic redundancy is asymptomatic, conservative treatment is advisable, whereas symptomatic patients should undergo extensive evaluation and individualized surgical approach. This recommendation is based on the most recent and highest quality study by the international network on oesophageal atresia (INOEA) consensus guidelines, published in 2023 in Nature Reviews Gastroenterology and Hepatology 1.
The study highlights the importance of evaluating the patient's symptoms and anatomy before deciding on a treatment plan. For symptomatic patients, a thorough preoperative investigation is crucial to assess the anatomy, functional performance, and vascularization of the transposed colon 1.
Some key points to consider in the management of colonic redundancy include:
- Asymptomatic patients can be managed conservatively
- Symptomatic patients require extensive evaluation, including endoscopy, contrast study, and CT or MRI scan
- Surgical approach should be determined on an individual patient basis, considering factors such as anatomy, functional performance, and vascularization of the transposed colon
- Various surgical approaches are available, including colonic conduit revision, colon–gastric disconnection with Roux-en-Y colon–jejunal anastomosis, and reverse gastric tube oesophagoplasty 1.
It is essential to consult a gastroenterologist or a specialist in oesophageal atresia for proper diagnosis and treatment planning, as the management of colonic redundancy requires a personalized approach.
From the Research
Redundant Colon
- The concept of a redundant colon is mentioned in the study 2, which discusses the surgical treatment of the redundant interposed colon after retrosternal esophagoplasty.
- According to this study, redundancy of the interposed colon used as an esophageal substitute is a common finding in the long-term follow-up of these patients.
- When symptoms caused by food retention in the colonic loop occur, surgical correction is necessary to improve quality of life and to prevent aspiration.
Treatment of Redundant Colon
- The study 2 reports a technique to straighten the redundant colon that consists of a side-to-side colocolic anastomosis using a linear stapler.
- This technique obviates the need for a redo cologastric anastomosis and is compared to resection of the loop, which is considered a quicker, safer, and easier operation to perform.
- The study suggests that this technique may decrease the risk of injury to the marginal vessels of the colon graft.
Relationship to Constipation
- While the concept of a redundant colon is not directly related to constipation, the study 3 discusses the evaluation and management of chronic constipation, which may be relevant to patients with a redundant colon.
- The study 4 also discusses the pathophysiology and current therapeutic approaches to constipation, including the use of fiber supplementation and laxatives.
- The study 5 provides an updated systematic review and meta-analysis of randomized controlled trials on the effect of fiber supplementation on chronic constipation in adults.
- The study 6 evaluates the usefulness of psyllium in rehabilitation of obstructed defecation, which may be relevant to patients with a redundant colon.