The reversed gastric esophagoplasty in palliation of carcinoma of the esophagus.

The reversed whole stomach was used in 29 patients to bypass nonresectable carcinoma of the esophagus. The mobilized distal stomach, after duodenal transection immediately beyond the pylorus, was placed in a substernal and anterior mediastinal tunnel and the prepyloric area was anastomosed to the cervical esophagus. Lengthening of the stomach was obtained by division of the lesser curve. In this series, the operative mortality rate was 4 per cent, morbidity was minimal and the whole procedure proved relatively easier to perform than the conventional isoperistaltic gastric esophagoplasty. There is no expected improvement in life expectancy, but morbidity decreased because of preservation of the esophagogastric drainage, thus avoiding a mucocele of the excluded esophagus and preservation of the vagus nerves.