Determination of the essential length

The black bars show alternative lines for transection of the colon. Resection of bluish margins on the right flexure of the transverse colon between the middle and the right colic artery should be performed under preservation of the paracolic arcades. Following this procedure, a better mobilization of the colonic segment can be obtained. To perform the pharyngocolostomy in carcinomas of the upper third of the esophagus, a fairly long colonic segment is required. Therefore parts of the sigmoid colon have to be used and the first (and probably the second) sigmoid artery has to be ligated close to the inferior mesenteric artery. Prior to dissection of the vessels, a clamp is provisionally applied to prove the sufficiency of the vascular supply. Dark arrows point to the vascular resection margins. The arcade between the right and middle colonic artery should be preserved for a better vascular supply of the colonic segment chosen for interposition (B).

Advantages of using the left colonic segment are the following:

1. The more predictably longer length and the smaller diameter of the left colon

2. Adequacy of the vascular pattern due to arteries with larger diameter, instead of vascular supply via several arcades as in the right colon

3. Using an anisoperistaltic colonic segment has no clinical relevance because the nutritional transport follows gravity

The essential advantage of the left colon is the opportunity to obtain a longer colonic segment.

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