Esophageal reconstruction: an experimental approach to the control of reflux after esophageal resection.

A study of the properties of replacement gastric tubes and colonic segments, and their use in the prevention of reflux after esophageal resection indicates that, in order to prevent reflux, these tubes must be maintained in a subdiaphragmatic position. Gastric tubes have a higher intrinsic pressure barrier than colonic tubes--a 2.5- to 6-cm segment prevents reflux and the tube maintains a pressure barrier 10 cm H2O higher than stomach presure, whereas colonic segments require 12 cm of subdiaphragmatic length to control reflux and maintain a pressure barrier only 2 cm H2O above gastric pressure. Removal of the intrinsic pressure barrier by myotomy allows free reflux in tubes that previously had prevented reflux.