Free ileal autograft as a substitute for the thoracic oesophagus : an experimental study in adult dogs and puppies

The urge for providing a better, more physiological method of reconstructing the thoracic oesophagus is very actively felt in paediatric surgery. For in paediatric surgery small defects in the thoracic oesophagus e.g. oesophageal atresia, peptic or caustic strictures, are bypassed with colon or stomach with considerable morbidity as a result (Otherson et al. 1967, Rehbein and Schweder 1971 ). In these cases large or small segments of viable oesophagus are resected or bypassed, often inclusive of the lower oesophageal sphincter. In oesophagoplasty for benign disease the aim of the surgical reconstruction should be threefold: to save as much oesophagus as possible; to preserve the sphincter; to provide the best functional substitute. Some efforts have been made to meet these objectives. Waterston (1964) introduced a technique that preserved the lower oesophageal sphincter, 12, using a pedicled colonsegment. This technique however, brings along the morbidity inherent in colonic substitutes. Pichlmaier (1973) interposed a pedicled segment of jejunum in the lower part of the oesophagus preserving the lower oesophageal sphincter. This method still has the disadvantage of a vulnerable vascular pedicle and is therefore limited to the lower part of the oesophagus. From the progress in autografting intestinal segments in the cervical region a logical sequel is to perform an analogous operation in the thoracic cavity.