[Autologous replacement of the cervical esophagus. Free jejunal interposition in a microsurgical technic as a replacement of the esophagus with function studies in an experiment].

The replacement of the esophagus using multiple-stage procedures and requiring a double cavitary approach has been burdened with a high post-operative lethality rate. A replacement of the esophagus using a free autogenous jejunal interponate by avoiding a double-cavitary approach has a lower lethality rate. The hitherto grafting procedures using macrosurgical vascular transplantation techniques were burdened with such a high thrombosis rate that no competitive alternative has ensued. Furthermore, different publications did not clarify whether or not the autogenous intestinal graft retained its peristaltic or, as Nakayama et al. (1964) reported, changed into a rigid and inflexible conduit composed of connective tissue. In a collective of 18 Beagles the esophagus was replaced using a autogenous jejunum graft. The vascular anastomoses between the interponate and neck vessels prepared using microsurgical techniques and the esophago-jejunal anastomoses were prepared using a one-row multiple layer suture. No animal died as a result of the operation. Necrosis of the interponate due to microthrombosis in the vascular anastomoses did not occur. The peristalsis began after opening the arterial vessel. Peristalsis remained even after one year. Histological investigations showed that the intestinal villi degenerate but the musculature and ganglion cells from the myenteric plexus remain intact. The interponate does not become fibrous. In approximately 1/3 of the cases, periluminal scar-tissue growth caused a stenosis of the interponate. This complication was resolved by surgical revision.