Is it possible to live without an esophagus? For most of us, this question sounds abstract. Yet patients who have ingested caustic substances – often children by accident, and adults as a result of suicide attempts – face a dramatic challenge. Chemical burns to the upper gastrointestinal tract can cause severe strictures and adhesions.
Researchers at Wroclaw Medical University analyzed treatment outcomes in 147 patients who underwent a procedure to replace their esophagus with a segment of intestine between 1990 and 2010. This is one of the most complex surgical procedures – it requires immense precision and the combined expertise of the entire medical team.
“The esophagus is a remarkably simple organ, but it passes through three anatomical regions – the neck, the chest, and the abdominal cavity. This makes the surgery extremely demanding. Reconstructive esophageal surgery differs from resective surgery in that the surgeon must create a new organ using the stomach or intestine,” explains Dr. Sławomir Woźniak.
Why the Intestine?
In esophageal reconstructive surgery, the stomach is typically used; however, this is not always possible, especially when the stomach itself has been damaged. In such cases, the intestine becomes the alternative. Surgeons may use a segment of the small intestine (jejunum) or a segment of the large intestine (colon).
Segments of the jejunum usually yield the best outcomes. Their diameter closely resembles that of the esophagus, and their smooth walls and gentle peristalsis facilitate the effective transport of food. Colon segments, on the other hand, are longer but have characteristic folds and are wider, causing food to move more slowly than it does through a natural esophagus.
“Based on years of experience, we know that esophageal substitutes made from the small intestine perform better than those made from the colon – due to their structural similarity to the native esophagus and their active, one-way peristalsis,” adds Prof. Krzysztof Grabowski.
A Chest-Free Operation
Surgeons developed a technique in which the intestine is moved through a newly created retrosternal channel – behind the sternum. This approach avoids thoracotomy (opening the chest), significantly reducing the risk of complications.
The entire procedure lasted an average of 5–7 hours. It involved three stages: preparation of the intestinal segment in the abdominal cavity, pulling it through the anterior mediastinum, and anastomosis with the pharynx or the healthy section of the cervical esophagus.
Most patients were able to return to normal swallowing and eating after reconstruction. However, some experienced complications:
- Diverticula in the cervical segment (approx. 3% of patients)
- Pleural hernias requiring reoperation (also approx. 3%)
- Dilation of the colon-based substitute (3%)
- Anastomotic strictures (1–2%)
- Ulceration due to reflux (1–2%)
Interestingly, patients with jejunal grafts had fewer complications, and food passage was quicker and more natural.
Experience Makes the Difference
The authors emphasize that surgical experience is a crucial factor in achieving success. In centers with less experience, perioperative mortality rates as high as several percent were reported. Thanks to decades of clinical work and technical refinements, the Wroclaw team maintained a low complication rate.
“The group of patients analyzed in our study was treated in accordance with the principles of the Wroclaw school of esophageal reconstruction, founded by Prof. Zdzisław Jezioro. It’s a unique data set, due to both its size and the long-term follow-up,” notes Dr. Sławomir Woźniak.
A New Esophagus, A New Life
Although it may sound like a medical paradox, the intestine can become a fully functional substitute for the esophagus. Patients who were unable to swallow even a drop of water before surgery regained the ability to eat normally after reconstruction. This not only saved lives but also restored a sense of normalcy after traumatic experiences.
“The ability to reconstruct the esophagus using the intestine or stomach allows patients to eat naturally, by mouth, without needing feeding tubes or parenteral nutrition. Quality of life improves significantly,” emphasizes Prof. Krzysztof Grabowski.
Despite the impressive results, esophageal reconstruction remains a surgical challenge.
“The surgeon must decide which intestinal segment to use during the operation, based on intraoperative assessment of blood supply. This is a critical decision. Intraoperative Doppler ultrasound of the vascular pedicle could be an invaluable tool,” explains Dr. Sławomir Woźniak.
This article is based on the scientific publication: Successes and failures of using the intestine as a pedicled oesophageal substitute of corrosive burns
Authors: Slawomir Wozniak , Krzysztof Grabowski, Renata Taboła
Scientific Reports, 2025, vol. 15, art. 28532