Replacements of the esophagus

Abstract

The esophagus may be replaced by various means. The skin tubes fashioned from the anterior thorax which were formerly used to restore continuity after esophageal resection have been superseded by more direct methods. Resection of the esophagus for both malignant and benign disease has become a common-place procedure. The ability to surgically remove many types of esophageal disease is well established. Some uncertainty still exists about the best method of restoring gastrointestinal continuity after esophageal resection. The stomach is admirably suited for use as an esophageal substitute. It is easily mobilized and has attributes which make its use favorable from most aspects. Its shortcomings are minimal even when it is used in the treatment of benign disease. Experience has shown that if the esophageal resection is extensive and the esophagogastrostomy is performed at a high level in the thorax, esophagitis is not a frequent development. The jejunum and colon are often used as esophageal replacements. The jejunum has certain limitations related both to its anatomically short vascular arcades and to certain physiologic and long term observations of patients undergoing these replacement procedures. The use of the colon presents fewer technical difficulties than does the jejunum, and is well suited for total or nearly total replacement of the esophagus. A discussion is presented here which questions the justification of the use of the colon or jejunum in the management of malignant disease of the esophagus. It is suggested instead that the stomach is a more satisfactory esophageal substitute in these instances. In the treatment of benign esophageal stenoses the colon or jejunum should find their greatest use as esophageal replacements.