THE CHOICE OF THE METHOD OF INTRATHORACIC PLASTIC OPERATION TO FORM ARTIFICIAL ESOPHAGUS FROM SMALL AND LARGE INTESTINE.

Abstract

The existing methods of intrathoracic plastic procedures, although possessing certain shortcomings which limit their use, gradually replace antethoracic plastic methods in the presence of proper indications, mainly depending on the level of the burn. On the basis of our experience (118 intrathoracic plastic operations), we became convinced that the following methods were the best: 1. In stricture of the abdominal end of the esophagus and of the whole stomach or only of the whole stomach, we recommend the third transmedial plastic procedure — esophago - intestinal anastomosis. This esophageal plastic procedure is completed in one stage through the abdominal cavity easily and rapidly; almost all the length of the natural esophagus is retained and so a lesser length of mobilized intestine is required. Scars on the skin of the chest and neck are absent and there are no visible intestinal loops (good cosmetic effect). 2. In constriction of the medial and inferior third of the thoracic portion of the esophagus, the best type of esophagoplasty is a single-stage formation of a bypass intrapleural esophagus from small or large intestine. Good patency of the esophagus is thus created with participation in the digestive act of the unchanged portions of esophagus and stomach. The plastic procedure is single-staged. A good cosmetic effect is obtained and there are no visible intestinal loops or scars on the neck. 3. In high burns of the esophagus, the anterior intrapleural plastic method is expedient. Pressure on and flexion of intrapleurally located intestine is avoided, and in this way, its blood supply and peristalsis are not disturbed. Free localization of the intestine in the pleural cavity permits rapid propagation of the swallowed food by means of peristalsis (this is confirmed roentgenologically). In addition, the intestine is buried within the thoracic cavity, which is of importance from the cosmetic point of view. An intrathoracic plastic procedure is the method of choice in children under five years of age, in markedly weakened patients, and in cases where there is a doubt as to the adequacy of blood supply of the mobilized intestine. As to the choice of the intestinal segment for plastic procedure, we consider that large intestine should be chosen in view of its better blood supply, lesser number of loops, and larger diameter.