Esophageal reconstruction for esophageal strictures or resection after corrosive injury

A total of 75 esophageal reconstructions were performed for caustic esophageal strictures (65 patients) or postcaustic resection (10 patients) at Naval General Hospital and National Cheng-Kung University Hospital from September 1976 to April 1991. Reconstructive procedures included bypass in 61 patients, replacement of the esophagus through the substernal route in 10, and replacement of the esophagus through the posterior mediastinum in 4. Esophageal substitutes used for reconstruction were a long segment of the ileum and the ascending colon in 42 patients; a short segment of the ileum and the ascending colon in 18; the ascending colon and transverse colon in 3; the ascending, transverse, and left colon in 1; the transverse and left colon in 6; the jejunum in 2; and the stomach in 3. All but two of the esophageal substitutes were isoperistaltic. There were 28 postoperative complications in 24 (32%) of the 75 patients. Cervical anastomotic leakage occurred in 5 patients (6.7%). There were no operative deaths. Postoperatively, swallow function was considered good in 67 patients (89.3%). In this experience, isoperistaltic transposition of the transverse and left colon provided the best results.