Reconstruction of the Esophagus

Surgical reconstructive methods after resection of the esophagus varies according to the location of the lesion. For lesions of the esophagocardiac junction, intrathoracic esophagogastrostomy through a left thoracotomy with transdiaphragmatic laparotomy has been done, but recently reconstruction by Roux-Y esophagojejunostomy or segmental jejunal interposition between esophagus and duodenum have been preferred. For lesions of the thoracic esophagus, esophagectomy through a right thoracotomy followed by laparotomy is our routine approach. The reconstructive method is cervical esophagogastrostomy by bringing up the stomach through a retrosternal tunnel. For lesions of the cervical esophagus, an effort should be made to preserve the larynx. The routine procedure consists of extraction of the thoracic esophagus, bringing up the stomach through the posterior mediastinal tunnel followed by cervical esophagogastrostomy. For advanced lesions of the hypopharynx, extraction of the esophagus is combined with pharyngolaryngectomy and permanent tracheostomy. Reconstruction is effected by pharyngogastrostomy. The extraction of the esophagus is performed by blunt finger dissection, eversionstripping with a vein stripper, or dissection with ring dissector. All these esophageal reconstructive procedures have been performed with small surgical risks (operative mortality rate 2/107, 1.9%).