Nicks, R. (1973).Thorax, 28, 498-510. Restoration of the strictured gullet. Local plastic procedures which restore the lumen of the oesophagus are a satisfactory mode of treatment for patients with localized strictures, provided the remainder of the oesophagus is healthy and that a valvular sphincteric mechanism is restored.
Replacement of the irretrievably damaged oesophagus by an isoperistaltic graft of jejunum or colon in its original bed at a single operation is safe and satisfactory. In some circumstances retrosternal replacement is preferred. Subcutaneous placement is reserved for situations where viability is doubtful.
Experimental and clinical experience indicates that healthy isolated interposed grafts of the right length function well provided there is a free outflow from the stomach.
Grafts which are initially too short, or which have undergone terminal necrosis and are exteriorized to the anterior chest wall, will elongate in time, permitting subsequent retrosternal replacement and cervical anastomosis.
The terminal segment of oesophagus damaged by caustic stricture should be excised as a prophylaxis against cancer in later life.
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