Experimental Replacement of the Cervical Oesophagus With a Free Transverse Colon Autograft Using Microvascular Anastomoses

Abstract

Microsurgical revascularization In the neck has Improved the survival rate of free small-bowel grafts used to replace the cervical oesophagus. Colon vessels are larger than those in the jejunum, and even with naked-eye technique good results have been reported lollowing free colon grafting of the oesophagus. The authors thought it might be possible to achieve even better results using microvascular anastomoses in the neck, and In this way replaced the cervical oesophagus in each of 15 dogs with a free transverse colon autotransplant. Four dogs died during operation and lour within three days, two of the latter with graft necrosis. The next seven dogs survived eight days or more, and all their colon grafts were viable. Where patent arteries were demonstrated (three cases) the mucosa and myenteric plexuses of the graft survived. In ail four dogs where the arteries were thrombosed or not demonstrated, the mucosa was absent, myenteric plexuses were absent in three, and one graft was grossly stenosed. Among these seven dogs there were three fistulae, one where graft arterler were patent and two where they were not; immedlate anastomotic healing Was not guaranteed by graft survlval or arterial patency.