That the difficulties of an ante-thoracic artificial esophagus constructed of rubber tubes are not insuperable is shown both by Garlock's cases and also by a young man who evolved an apparatus of this kind himself and used it to overcome the effects of a failed attempt to construct a skin tube in the treatment of what was regarded as an impassable simple esophageal stricture. This stricture was eventually dilated satisfactorily, but before this the patient had worn his apparatus for nineteen years without any but his intimate friends knowing that he had suffered from any disability.
Exceptional co-operation on the part of the patient is required for the satisfactory functioning of this type of apparatus, and on the whole it would seem more desirable to attempt the formation of a new esophagus, either outside the chest in the form of a skin tube anastomosed to a Beck-Jianu type of gastrostomy or by leaving the stump of the esophagus in the thorax and anastomosing it to small intestine or stomach drawn up to meet it.
SUMMARY
I. Two cases are described in which the thoracic esophagus has been completely removed for carcinoma, one patient being alive and well to date, the other surviving sixteen months.
- The advantages of approaching the esophagus from the right side of the thorax are discussed.
I am indebted to Professor Grey Turner for his encouragement and advice in the management of these cases and also for the opportunities which I have had of discussing with him problems associated with esophageal surgery. My thanks are due also to Dr. Allen Daley, Chief Medical Officer, London County Council, for permission to publish these cases.
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