Successes and failures of using the intestine as a pedicled oesophageal substitute of corrosive burns

Anatomy is the primary factor in planning and performing reconstructive surgery of the oesophagus. When it becomes necessary to replace the natural, pathologically obstructed oesophagus-for example, after corrosive intake-a tube can be created using the stomach or intestine. We performed intestine-based reconstructions of injured and obliterated oesophagi in more than 300 patients. Of these, 147 (60 women, 70 men, and 17 children: 7 girls and 10 boys) treated between 1990 and 2010 were analysed in this study. The decision to use the intestine, whether large or small, as a substitute was based on its vascular supply, which was assessed intraoperatively. The reconstruction was performed using a pedicled intestinal segment, with the colon utilized in approximately 35% of cases, the jejunum in 30%, and a combination of large and small intestines in the remaining cases. In most patients who underwent surgery, recovery was uneventful; however, complications occurred in a few cases. We observed cervical diverticula in 5 patients (3.4%; 2 females, 3 males), pleural hernias in 5 patients (3.4%; 2 females, 3 males; all of these patients underwent reoperation), colic tube distension in 5 patients (3.4%; 3 females, 2 males), cervical stenosis in 2 patients (1.4%; 1 female, 1 male), and ulcerations in 2 patients (1.4%; 1 female, 1 male). Additionally, one female patient exhibited a genu-like flexion in the intestinal segment, while two patients (1 female, 1 male) developed ulcerations in the intestinal substitute. Another female patient had a large colic remnant. The best results in restoring the passage between the pharynx and stomach were achieved using jejunal segments, as they provided an identical lumen diameter for anastomosed segments. The experience of the surgical team was a key factor in achieving successful outcomes.