Prosthetic replacement of the esophagus.

A tubular prosthesis was initially made of silicone rubber, spot-bonded on the inside and outside to a layer of knitted Dacron. This was covered on the outside by a loose layer of knitted Dacron, attached to the rubber only at the two ends, to allow incorporation by fibrous tissue and fixation of the prosthesis. Anastomoses were made with one layer of continuous sutures. There was initial incorporation of the graft. After 29 to 44 days the tube became loose and migrated, leaving a stricture. The prosthesis was redesigned with two loose layers of wider mesh. Incorporation occurred early with abundant fibrous reaction. Separation of the tube started at 40 days and was complete within 72 to 152 days. When the sutures became disengaged, bacteria entered the space between rubber and incorporated fabric, resulting in collagen lysis and separation of the tube. There were no anastomotic leaks in the entire series.