Willy Coosemans

Options for Esophageal Replacement

Abstract Esophagectomy followed by reconstruction is considered one of the most challenging interventions on the alimentary tract. Today most esophagectomies are performed for cancer of the esophagus and gastroesophageal junction. Other indications are decompensated achalasic megaeesophagus, sequelae of caustic burns, after multiple redo surgeries for reflux. The stomach, shaped into a narrow gastric tube, is the most commonly used conduit for reconstruction due to its favorable length, reliable vascular supply, the need for only one single anastomosis, and, in general, good to excellent sustainable quality of deglutition and life. However, dependent on each individual patients particularities, reconstruction may require to choose another conduit. Colon and jejunum—sometimes to be used as an isolated loop with free vascular anastomosis or as composite grafts—are the available alternatives. Tubular skin flaps in an extremely rare situation may become the last resort option. Combined with a multitude of different access routes, including the recent minimally invasive techniques, as well as different levels of anastomosis, it is clear that there are myriad options available when planning an esophagectomy and reconstruction. A tailored approach for each individual patient guided by an experienced surgical team that is familiar with all conduits available and able to adapt to every situation in order to offer the patient the best possible type of reconstruction is the key to success. This chapter provides an in-depth description of the techniques and results of the whole spectrum of options for esophageal replacement.

Clinical Experience with the Bioabsorbable Anastomosis Ring in Bowel Surgery

In Quenu’s Traite de Technique Chirurgicale of 1955, seven pages deal with anastomotic techniques using different types of buttons. Besides the well-known Murphy button (Murphy 1892), other similar devices are illustrated in this book, like the Jaboulay-Lumiere button used for sideto-side anastomosis without the need for a pursestring suture (Fig. 1) and the Villard (1896) and Pouliquen devices. In an interesting comment by the editor, the advantages — speed, possibility of creating an anastomosis under difficult circumstances, aseptic technique — and the disadvantages — difficulty, irregular scarring, obliteration of the lumen, problems of elimination — were put forward. A dispute even originated between “buttonists” and “suturists.”