The colon has become an effective and reliable graft for esophageal reconstruction. The in-depth knowledge of colon vascular anatomy is very essential to select an optimal graft. However, the colon interposition remains a surgical procedure associated with a high risk of graft ischemia. The graft ischemia is a dreaded complication which can impact the graft viability and the surgical outcomes. Various investigations have been used to assess graft blood supply and confirm the diagnosis of ischemia during colon interposition .Several strategies have been described to deal with this complication when it occurs intraoperatively. According to the patient conditions, the surgeon should be able to define the appropriate treatment strategy to deal with this complication. As colon interposition is a high-risk procedure, the preoperative identification of the risk factors, optimization of patient condition, and meticulous operative technique are required to reduce the risk of graft ischemia while selecting a colon graft for esophageal reconstruction.
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