Late complications of coloesophagoplasty and long-term features of adaptation.

Objectives: Revisional surgery of late complications after 141 substernal by-pass operations (1962-1990), except three cases with isoperistaltic (except seven with anisoperistaltic) transverse colon grafts for caustic esophageal strictures, are presented. Long-term adaptation of the grafts was investigated with cineradiographical and histochemical methods.

Methods: Correction of the "pseudodiverticulum" of the proximal anastomosis as a complication of the standard by-pass procedure (in five patients) was achieved by closure of the esophagus below the anastomosis or by end-to-end reanastomosis.

[Adaptation of the esophagus, reconstructed using the colon, based on 135 cases of surgery in corrosive stenosis].

Late aspects of adaptation were studied on the basis of 135 esophagoplasty by means of isoperistaltic (except of 7 anisoperistaltic) transverse colon for corrosive strictures. Histochemically, the augmentation of neutral mucopolysaccharide, which increases mucosal resistance--was observed on the surface and in Lieberkühn glands of colonic mucosa. Mucosal absorption remains unmodified.

Bypass with transdiaphragmatic Roux loop in nonresectable malignant stricture of the lower oesophagus.

Bypass with a Roux-en-Y loop is proposed for palliation of nonresectable malignant obstruction in the distal oesophagus and cardia without peritoneal dissemination. Over a 15-year period, 51 transdiaphragmatic Roux-en-Y procedures with side-to-end oesophagojejunal anastomosis were performed. The 11.