BOWEL INTERPOSITION FOR ESOPHAGEAL REPLACEMENT - 25-YEAR EXPERIENCE

Background. From 1972 to 1996, bowel interposition reconstruction afte r esophagectomy for benign and malignant conditions was performed ire 129 of 131 patients, The indication for operation was benign disease i n 94 patients (72.9%) and malignant disease in 35 patients (27.1%). Be nign stricture was the most common presentation in the benign group (4 1 patients), and adenocarcinoma was the most common indication In the malignant group (19 patients). Methods. One hundred thirty-three condu its were performed in the 129 patients. Four patients (3.1%) required reoperative reconstruction. Of the 97 conduits employed for reconstruc tion of beni,on disease, the right colon was used in 70 patients, the left colon in 9 patients, and the transverse colon in 4 patients. A je junal interposition graft was employed in 11 patients and a free jejun al autograft in 3 patients, The right colon was used in 15 patients wi th malignant disease, the left colon in 9 patients, and the jejunum in 12 patients. Results. The mean age of the population was 54.5 years ( range, 14 to 72 years) with a male-to-female ratio of 1.3:1. The avera ge number of prior thoracic or abdominal procedures was 2.9 (range, 1 to 8) with 50.9% of patients undergoing reoperation The mean length of stay was 21.7 days (range, 8 to 290 days). Complications occurred in 37.1% of patients with anastomotic leak occurring in 14.8% and ischemi c colitis in 3.0% of conduits performed. The in-hospital mortality was 5.9%. Conclusions, Bowel interposition reconstruction after esophagec tomy for benign and malignant disease can be performed with an accepta ble morbidity and mortality, despite prior operative procedures in the abdomen or chest. Colonic and jejunal conduits, employed alone or in combination, can effectively restore gastrointestinal continuity. (C) 1997 by The Society of Thoracic Surgeons.