Esophageal reconstruction.

Experience with 112 esophageal reconstructions in 108 patients employing an overall philosophy for this problem is summarized. In patients with malignant disease, the reconstruction should be the quickest and simplest possible, and a higher long-term complication rate caused by the reconstruction may be acceptable. Experience with the use of the stomach demonstrates that the mortality and complication rates are acceptable but that the stomach has the clear disadvantage of a higher incidence of postoperative aspiration pneumonia, which adds to mortality, and an incidence of serious complications from reflux esophagitis. These late specific complications after esophagogastrostomy are not acceptable in the treatment of patients with benign disease, so the use of intestinal segments, descending colon or jejunum is advocated. Both have the hazard of venous infarction, although the risk of anastomotic leakage, aspiration and late esophagitis is diminished or eliminated. In desperate circumstances, an extracorporeal tube to restore alimentation may be useful in reconstructing the esophagus.