Reversing esophageal discontinuity.

Catastrophic esophageal or gastric disruption drive the decision to "disconnect" the esophagus to prevent ongoing mediastinal soilage. The operations used to establish esophageal discontinuity are not standardized and vary widely, the surgeon often focusing on saving the patient's life, not on how alimentary continuity will ultimately be restored. Patients who survive the initial disastrous infectious complications are typically desperate to have further surgery to allow them to eat again. Relatively little is written about the decisions involved in reversing esophageal discontinuity--the timing of the operation, preoperative assessment and preparation, planning and conduct of the operation, and outcome. The nuances of reestablishing alimentary continuity in this disparate patient population are the focus of this article.