[A new concept in esophageal reconstruction with colon (considerations on 329 operated cases)]

The author reports a personal series of 329 cases of coloesophagoplasty from various etiology, the majority of them carried out for corrosive pharyngoesophageal strictures (276), followed by malignancy (44). A personal philosophy is exposed, based on more flexibility in the choice of the type of colic interposition depending on the pattern of blood supply. This mobile policy called "balanced operation" is opposed to the classic rigid approach based on the use of a single procedure in coloesophagoplasty. His choice is the ileocecum with long ileal loop (65 cm), favoring preservation of the ileocecal valve, and confering an antireflux mechanism. In particular cases the cecum may be removed and an ileal graft carried out. If this arrangement is not feasible one should slide toward the left in a clockwise direction performing a left colon interposition (iso- or antiperistaltic). Overall mortality was of 16 cases (4.9%). Morbidity is analysed and different particular arrangements like continuous colic loop, superlong graft, Roux en Y procedure are described. A general outline of pharyngeal reconstruction in corrosive strictures is presented.