ABSTRACT
The use of the stomach as an esophageal substitute was introduced by Kirschner in 1920 as a nonresectional operative bypass. His operation consisted of skeletonization of the greater curvature of the stomach, and the mobilized stomach was then brought subcutaneously up to the divided cervical esophagus. The stomach may be used as an esophageal substitute only if it has not previously been operated on. After gastric resections, the length will be insufficient, and after vagotomy procedures, the vascularization is doubtful. The type of anesthesia used depends more on the type of esophagectomy than on the method of reconstruction. If an intrathoracic anastomosis is to be performed, a double- lumen endotracheal tube should be used. Skeletonization of the stomach begins along the greater curvature outside the gastroepiploic arch. The whole stomach, rather than a gastric tube, can be used as the esophageal interposition. This can be done only if the tumor is not infiltrating the gastroesophageal junction.
