The enigmatic esophageal anastomosis

Esophageal reconstruction after esophagectomy remains one of the major challenges to esophageal surgery. Despite over 100 years of innovation and medical engineering since the first successful human esophagectomy, we as surgeons continue to debate the merits of individual techniques and revisions. Why? Because the long and short-term effects of esophageal resection are intimately associated with the surgical reconstruction of the foregut, much of the time surgeons spend on esophageal resection is devoted to this very topic. While in clinic we discuss with our patients the ramifications of leak and loss of the lower sphincter. A similar time commitment is dedicated to actually fashioning a relatively simple reconstruction in the operating theater. We then worry for the next several weeks over the short-term outcome. For several years later, the surviving patient will be reminded not to over-eat, not to sleep flat, and to limit meals prior to bed to avoid regurgitation that may lead to aspiration.