Delayed anastomosis of the cervical portion of the esophagus in bypass operations for unresectable carcinoma of the esophagus.

To prevent the high incidence of anastomotic leakage in a bypass operation for unresectable carcinoma of the esophagus, we devised a two stage bypass procedure, in which the anastomosis of the cervical portion of the esophagus to the gastric tube is delayed for about two weeks after the first operation. With this approach, the short segment of the cervical part of the esophagus adequately adheres to the surrounding tissue by the time of the second operation, and the anastomotic site no longer responds to the strong force accompanying deglutition. One-half of the anastomotic leaks which occurred on the one stage procedure was reduced to nil when the two stage approach was done.