Intestinal bypass of the oesophagus: 117 patients in 28 years

This study includes 117 patients operated upon in the period from 1970 to 1 999. Indications, surgical techniques, complications, and results are revie wed. Indications included: long-gap oesophageal atresia with or without fis tula in 81 patients; peptic stenosis in 19: caustic stenosis in 12; oesopha geal varices in 2; and 1 case each of oesophageal epidermolysis bullosa, to tal oesophageal leiomyomatosis, and a non-functioning antiperistaltic retro sternal colic graft operated upon in another hospital. A retrosternal bypas s was performed 106 times: 98 first operations and 8 redos; the intrathorac ic technique was used 19 times. The left transverse colon was used in 107 c ases (85.6%), the right transverse colon in 8 (6.4%), and the ileocecum in 10 (8%). All the intestinal bypasses were placed in the isoperistaltic dire ction. There were 5 deaths in the first 11 years of our experience; no pati ent died from 1982 on. Ten complications were treated conservatively (8%): 2 wound infections healed with medical treatment, and 8 leaks of the cervic al anastomosis closed spontaneously. The major surgical complications were 8 gangrenous bypassess (6.4%), removed and reopeated about 1 year later uti lizing an ileocolic retrosternal graft. Three cases of peptic disease of th e colic bypass (2.4%) were successfully treated with the author's technique . Nine patients had minor surgical complications (7.2%): 3 strictures of th e oesophagocolic anastomosis in a retrosternal bypass (resected and reopera ted) and 6 cases of adhesive occlusion. In our opinion, the best substitute of the oesophagus is the colon, particularly the left transverse segment, which may be placed behind the sternum or in the oesophageal bed, always in the isoperistaltic direction. The low mortality (4%), restricted to the ea rly period of our experience, and few major surgical complications (6.4%) a re acceptable considering the importance of the operation, and the long-ter m results may be considered very satisfactory.