Replacement of the Middle Third of the Esophagus with a Silicone Rubber Prosthesis

An Experiment and Clinical Study

¹ Southfield, Michigan

Efforts to bypass, substitute for, or investigate neoplastic obstruction in the middle third of the esophagus have posed an unsolved problem for surgeons. Accepting that a "cancer" operation with wide "enbloc" dissection of the lesion and its adjacent structures is not feasible in this area, a more simple, less extensive and more physiologic method was sought. Three problems are apparent:

1. An adequate dissection of the neoplastic mass with its adherence to the mediastinal structures is necessary.

2. A suitable replacement for the resected segment is needed.

3. A method of secure fixation of this prosthesis is needed.

A rather detailed account of the work of previous investigators has been recorded. Efforts to profit from their experience have been the basis for our decision to use Dacron and silicone rubber as the prosthesis. These grafts were checked bacteriologically and two series of dogs were utilized. In the first series, various suture techniques were employed for the placement of non-rigid silicone rubber- Dacron grafts. The end result, regardless of the suture technique employed, was stenosis. Our new grafts of a soft pliable nature have soft wall strength to preserve the lumen of the esophagus. They are fixed at both ends by plastic multi-toothed rings that do not interrupt the esophageal wall blood supply. The second series of dogs were operated with this new technique which is outlined pictorially in the text.

The basic aim of our graft insertion is not merely to provide a splint about which a regrowth of epithelialized fibrous growth will form. Our best efforts are bent on incorporating the graft as a permanent piece of the living esophagus. We think the principles we have tried to follow regarding methods of blood supply to the cut ends, a prosthesis of soft wall strength to maintain a patent lumen, preservation of anastomosis with pleura and simplicity of technique are essential to the solution of the problem. Three human cases have been done and a single case report is included.