Subcutaneous transposition of the proximal oesophagus in oesophagoplasty

Experience with a new technique of oesophagoplasty is presented, in which the proximal part of the oesophagus is transposed to the subcutaneous space in front of the sternum and anastomosed to the organ replacing the oesophagus. This kind of operation has been performed successfully in five cases. The advantages are: thoracotomy is avoided; oesophageal anastomosis is easily performed; anastomotic failure in the subcutaneous space is not a serious problem; revision of the anastomosis is easily performed under local anaesthesia; and the mortality rate due to oesophageal anastomotic failure is diminished. The procedure is indicated in cases where a long graft for oesophagoplasty is not available and intrathoracic anastomosis is not desirable. It may also be used after oesophagogastrectomy or total gastrectomy. The most common complication is the development of a salivary fistula that heals spontaneously in a few days.