[Reconstructive surgery of the oesophagus. Possibilities and organization]

For a number of anatomical and pathological reasons, reconstructive surgery of the oesophagus remains a difficult and complex surgical procedure. The vast experience of performing 1155 reconstructive surgical procedures at Prva hirurska klinika (First surgical clinic), part of Belgrade Medical Faculty, enables the author to reflect upon options and limitations of such operations. There is a considerable discrepancy between the results obtained from reconstructive surgery of the oesophagus and the cardia affected by malignant growths, and form treatment of benign strictures of the oesophagus--the latter producing significantly better results. Digestive tract tissue used in the reconstructive surgery, is applicable depending on the pathological condition, its location, the possibility of isolating a sufficiently long section, and its adequate vascularization. Best results were achieved when a segment of thejejunum was used, but only for distal lesions of the oesophagus. Good results were achieved also when segments of the colon were used, the left colon proving more useful than the right one. Stomach tissue produced the worst results in a series of reconstructions, because it was used primarily in cases where the oesophagus was affected by malignant growths. When comparing the data from this series with the findings from the world literature, we come to almost identical results as in cases of reconstructive surgery of the oesophagus affected with carcinoma. Our experience in reconstructive surgery treatment of benign lesions of the oesophagus produced consistently better results that those shown in reputable foreign statistics.