“…Further, in the hands of other investigators, the procedure carried an unacceptable mortality rate, reaching as high as 50% (Dragstedt & Mullenix 1931). It was subsequently shown that postoperative sepsis could be minimized, and the mortality rate consequently reduced by dividing the procedure into two stages, with incision into the oesophageal lumen preceded several days by surgical elevation of the cervical oesophagus to an external or immediate subcutaneous position (Dragstedt & Mullenix 1931, Friedman 1951, Komarov & Marks 1958. In leaving the posterior (dorsal) oesophageal wall intact between the oesophageal limbs, investigators were able to achieve some degree of natural feeding in their animals (Friedman 1951, Komarov & Marks 1958, Gantt et al 1968 while retaining the ability to obstruct the distal limb for sham feeding experiments; however, leakage of saliva, ingested fluid, and gastric refluxate through the fistula remained significant problems, resulting in excessive loss of electrolytes and development of perifistular dermatitis.…”