[Problems and difficulties in patients with esophageal reconstruction].

The esophageal reconstruction, independent of the manner and indication represents a major challenge for any surgical team. The goal of the present study is the retrospective analysis of cases together with the technical possibilities of surgical approach, viewed through the diagnostical and therapeutical point of view. We analysed retrospectively 154 patients (140 post-caustical stenosis and 14 neoplasms) who have took benefit of reconstructive esophageal surgery, operated in the last 21 years (1981-2001) in the clinic of surgery, of "Saint Mary" Hospital. Although the esophageal substitution has multiple indications (malignancy, benign stenosis, iatrogenic fistulas, reflux disease with peptic stenosis, etc.), in our clinic the technique was performed for neoplasic lesions and post-caustical corrosive stenosis. In the first period of the study (1981-1990) the most utilised method of surgical approach was the gastric tubulisation after the Gavriliu I or II procedures; in a second period (1990-2001) it is obvious that the tendency was to use the colon or the whole stomach as principal visceras for reconstructions. About the immediate results, the majority of post-operative complications where minors, the most frequent problem being of pleuro-pulmonary nature. We have registered two deceases of patients with corrosive pathology and no post-operative mortality in the first 30 days in neoplasic patients. We evaluated the post-operative functional results using an evaluation score. The anastomotic functionality was good or excellent in most cases (80%), especially in non-malignant reconstructions. For the selection of the most suitable reconstructive procedure, a variety of factors must be explored and evaluated. After a long period in which the use of the colon, in different technical manners, represented the "golden standard" in esophageal reconstruction, we have observed a reevaluation of this attitude and also the more and more frequent utilisation of the whole stomach as esophageal substitute, especially in malignancy.