Internal mammary vessels as recipient vessels in supercharged ileocolon interposition for esophageal reconstruction: a single-center early technical experience

Abstract Introduction Esophageal reconstruction remains challenging when conventional conduits are unavailable or unsuitable. Supercharged colon interposition may improve graft perfusion; however, optimal recipient vessels remain debated, particularly when cervical vessels cannot be used because of previous surgery, radiation therapy, or scarring. This single-center study describes a technical modification of the supercharged ileocolon technique, using the internal mammary vessels as recipient vessels via a minimally invasive, sternotomy-free intercostal approach. Patients and methods Between 1995 and October 2024, nearly 1,000 esophageal resections were performed at our institution. Microsurgical reconstruction was required in 49 cases (38 free jejunal grafts, 11 supercharged colon interpositions); among the latter, 7 patients underwent supercharged ileocolon interposition using the internal mammary vessels as recipient vessels. Data were extracted retrospectively from a prospectively maintained institutional database. Given the small sample size, no formal statistical analysis was performed; results are reported descriptively as absolute numbers, with percentages given as supplementary information only. Results Among 7 patients (mean age 42 years; range 18–76), 2 delayed primary and 5 secondary reconstructions were performed. Five of 7 patients (71.4%) had an uneventful postoperative course with satisfactory swallowing function. One patient (14.3%) developed an anastomotic leak that progressed to sepsis and death, and one patient (14.3%) developed graft thrombosis requiring graft removal. The internal mammary vessels were accessed through a left second-intercostal-space approach, in most cases without rib resection. Discussion This study describes a technical modification of the previously established supercharged colon interposition technique – the use of internal mammary vessels as recipient vessels via a sternotomy-free intercostal route – rather than a fundamentally new reconstructive principle. It provides structured early clinical data supporting the technical feasibility of this approach in patients with unsuitable cervical vessels, while confirming that this remains a high-risk salvage procedure. Conclusion Supercharged ileocolon reconstruction using internal mammary vessels accessed via an intercostal approach is technically feasible and represents a useful addition to the reconstructive armamentarium when cervical recipient vessels are unavailable. The small sample size and retrospective design preclude conclusions regarding efficacy or superiority; larger series with long-term follow-up are required.