The comparative studies were done on a total of 61 cases of esophagoplasty to treat benign esophageal stricture, which consist of 31 cases of antethoracal esophagoplasty and 19 cases of retrosternal esophagoplasty using jejunum, and 11 cases of retrosternal esophagoplasty using right colon,
An operative method of three stages antethoracal esophago-plasty using jejunum started in later on 1947, the technique was modified to two stages antethoracal or retrosternal means, and since 1958, one stage technique of antethoracal or retro-sternal esophagoplasty has been used up to the present time.
It was realized that one stage retrosternal esophagoplasty using isoperistaltic right colon was better than retrosternal one using jejunum.
In the retrosternal esophagoplasty using jejunum, there were no significant differences in postoperative general condition between the group bypassed stomach and the one communicated jejunum with stomach.
It was confirmed that jejunum and right colon were enough in length in the improved technique above mentioned and were satisfactory for passage function of food postoperatively. But it is necessary to exarrine the presence or absence of any defect in continuity of arcade artery in the colon, Therefore when jejunum and colon are mobilized and elevated upward through a subctanous or retrosternal tunnel, it is mandatory to push them upward gently in stead of retracting them from the neck side in order to prevent rupture of arcade artery.
The circumstances for esophagoenterostomy in the cervical region are the same in both jejunum and right colon. A postoperative fistula makes deformity in the anastomosed site of stoma and causes stenosis. It was effective to use a technique of securing an invaginated, peritonealized anastomosis of the esophagus for prevention of postoperative fistula. In addition, it was better to resect esophagus after careful evaluation of the pattern of organic change in the resecting esophageal margin to prevent postoperative stenosis and in some other cases, post-operative bougination were also effective.
It is convenient for esophagoplasty to do gastrostomy high in the fundus of stomach. Early gastrostomy deserves of rest of the esophagus, sufficient supplies of food and early detection of any pathological changes in stomach. Instrumentation of the esophagus in acute stage is dangerous, which may produce rupture of it and bougination in the case of chronic stricture are not effective to relive it.
There is no hard and fast rule in selection of jejunum or right colon as the transplanting bowel and an operative method, either antethoracal or retrosternal approach. It is better to determine a selection of them, case by case, after the cautious preoperative evaluations of length of the transplanting bowel, anatomy of arcade artery, condition of the mobilized intestinal loop, and possibility of the complications, such as necrosis of the transplanting bowel, when there was no possibility of the complications, retrosternal esophagoplasty using right colon was better in cosmetic point of view.
We experienced only one expired patient postoperatively, which was due to necrosis of jejunum in the mediastinum and acute mediastinitis. One case of failure was caused by rupture o farcade artery in the subcutaneous tunnel due to traction from the neck side. There two cases happened to be in the beginning of esophagoplasty in this series and there has been good postoperative results without any more postoperative death or failure since 10 years ago.
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