Unified approach for nonmalignant esophageal lesions using right colon and terminal ileum. A 30-year experience

Over the past 30 years, the authors reconstructed the esophagus with the right colon in 85 patients who had congenital and benign disease. The first individual operated upon in 1955 was asymptomatic. Nine patients had congenital tracheoesophageal fistula with atresia, four esophageal varices, 31 advanced obliterative esophagitis, and 23 corrosive destruction. In seven patients, severe esophagitis followed esophagogastrectomy, four had unsuccessful operations for achalasia, and seven had colon bypass following esophageal perforation. Eleven early nonfatal complications occurred. Remote nonfatal complications were seen in six patients. Three early deaths followed dehiscence of an intrathoracic esophago-colon anastomosis, and one patient died from peritonitis (4%). Four individuals died over the study period, and five patients were lost to follow-up. The late results in 72 patients show that 61 (84%) believe they have a satisfactory result, nine (13%) individuals are symptomatic, and two patients (4%) are classified as failures. Early complications have been minimized by employing preoperative intestinal angiograms and anastomotic stapling techniques, and by using the Doppler intraoperatively to prognosticate colon blood flow. Significant observations have been: Anastomosis in the neck is preferable; the transplanted colon dilates from loss of motor activity but is functionally adequate; an isoperistaltic segment is preferable, but antiperistaltic segments can be used; and colonic mucosa is relatively resistant to acid-peptic digestion.