title: Digestive tract reconstitution after failed esophago-gastro or esophago-coloanastomosis.
abstract: BACKGROUND
  Severe dysphagia or even aphagia can occur after esophagectomy secondary to necrosis of the ascended organ with severe stricture or complete separation of the stumps. Catastrophic esophageal or gastric disruption drives the decision to "disconnect" the esophagus in order to prevent severe septic complications. The operations employed to re-establish esophageal discontinuity are not standardized and reoperations for re-establishment of the upper digestive transit are a real challenge.
  
  
  METHODS
  This is retrospective study collecting the authors experience during 17 years including 18 patients, 14 of them previously submitted to esophagectomy and four to esophagogastrectomy. They were operated on in order to re-establish the upper digestive tract.
  
  
  RESULTS
  Redo esophago-gastro-anastomosis was possible in 12 patients, 10 through cervical approach and combined with sternotomy in four in order to perform the new anastomosis. In five patients a new esophago-colo anastomosis was performed. Free jejunal graft interposition was performed in one patient. Complications occurred in ten patients (55.5 %): anastomotic leaks in three, strictures in four, sternal condritis in two and cervical abscess in one. No mortality was observed.
  
  
  CONCLUSIONS
  There are different surgical options for the treatment of this difficult and risky clinical situation which must be treated with tailored procedures according to the anatomic segment available to be used, choosing the most conservative procedure.
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Chile, Santiago, Chile. cirugia@braghetto.cl
authors.forename: Italo
authors.initials: I
authors.lastname: Braghetto
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Cardemil
authors.forename: Attila
authors.initials: A
authors.lastname: Csendes
authors.forename: Aliro
authors.initials: A
authors.lastname: Venturelli
authors.forename: Mauricio
authors.initials: M
authors.lastname: Herrera
authors.forename: Owen
authors.initials: O
authors.lastname: Korn
authors.forename: Sergio
authors.initials: S
authors.lastname: Sepúlveda
authors.forename: Jorge
authors.initials: J
authors.lastname: Rojas
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery*; D004931:Esophageal Achalasia / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D004940:Esophageal Stenosis / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure