Alternativas de reemplazo esofágico: revisión de tema
DOI:
https://doi.org/10.30944/20117582.2701Palabras clave:
enfermedades del esófago, esofagectomía, esofagoplastia, anastomosis quirúrgica, estómago, colonResumen
Introducción. Posterior a una esofagectomía parcial o total, el reemplazo del esófago representa un reto para los cirujanos. La selección del sustituto dependerá de diferentes factores, tanto del paciente como del cirujano. Las alternativas disponibles son el estómago, segmentos del colon, el yeyuno supercargado o colgajos libres miocutáneos.
Métodos. Se realizó una búsqueda de la literatura en las bases de datos de Medline, Embase y Lilacs, utilizando las palabras claves descritas y aplicando una técnica en bola de nieve, y se seleccionaron los artículos más relevantes.
Resultados. El órgano seleccionado debe asegurar una adecuada red vascular, mantener la función deglutoria y tener los menores riesgos posibles. Cada sustituto tiene ventajas particulares, pero todos generan complicaciones a corto y largo plazo. El estómago es el más frecuentemente usado, sin embargo, el reflujo gastroesofágico y la gastroparesia pueden presentarse en un número importante de pacientes. El colon requiere diversos estudios preoperatorios y cada segmento tiene sus características particulares para el ascenso; a largo plazo puede alargarse, tornarse dilatado y tortuoso, afectando la calidad de vida. El yeyuno supercargado permite un adecuado ascenso sin tensión, pero implica una técnica quirúrgica más compleja.
Conclusiones. El tubo gástrico es la primera opción, por su menor complejidad técnica y buenos desenlaces. De no estar disponible, se cuenta como alternativas con los diferentes segmentos del colon, el yeyuno supercargado o los colgajos musculocutáneos. Las complicaciones asociadas a estos procedimientos no son despreciables, por lo que se debe tener muy en cuenta la experiencia del grupo quirúrgico.
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