Reconstruction of the esophagus by microvascular surgery.

After esophagectomy, free jejunal autografts were used for reconstruction in 11 patients and pedunculated colons in two patients. A microvascular technique was applied immediately after the resection. A vascular anastomosis gave a new blood supply for the free jejunal graft, and in the case of the pedunculated colon gave support to improve circulation. During the grafting procedure, neither cooling nor heparinization was needed. No graft failures have occurred. The main complication of free jejunal grafts was leakage of the proximal anastomosis of the bowel, but all three leakages healed spontaneously. Two supportive vascular anastomoses for the pedunculated colons were effective and caused no complication. All 13 patients could eat regularly at the time of their discharge.