Esophagoplasty with isoperistaltic stomach is a useful and satisfactory means of reconstruction of the esophagus. It is simpler and there is no necessity for using a reversed gastric tube. The most essential points of technique for the modelling of the stomach, is taking advantage of the ample intramural vascular network and adequate selection of the highest point of the stomach for the site of the esophago-or pharyngogastrostomy. To utilize the intramural vascular network, sufficient width of the stomach is necessary. This also allows stretching of the stomach. Esophageal resection and reconstruction using the isoperistaltic stomach above the level of the neck was performed on 130 cases. Among them 40 cases were pharyngogastromies and 90 cases were cervical esophagogastromies. There was one operative death due to alcoholic liver cirrhosis (operative mortality rate 0.8%). If the stomach is properly handled, esophageal replacement by the isoperistaltic stomach gives constant success.
The technique and results of oesophageal resection through a right thoracotomy and laparotomy with reconstruction utilizing the stomach via a retrosternal route are reported. Forty patients underwent this procedure, with no mortality. The average blood loss during operation was 424 ml, and 72% of this series underwent the operation without blood transfusion. It is believed that this type of one-stage operation for carcinoma of the oesophagus is reasonable from the viewpoint of adequate resection of malignancies, and it can be performed with minimal surgical risk. With experience, perhaps it will become a standard method such as the Billroth I method in gastric surgery.
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