A patient suffering from severe caustic lesions of the esophagus at the age of two was maintained with periodic dilatation for 20 years, with only liquid diet. Treatment was performed in one step by transhiatal esophagectomy under visual control with vagal trunk preservation. Reconstruction was done by isoperistaltic ileo-right colon substitute. Esophago-ileostomy (end-to-side) was performed on the left side of the neck. No pyloroplasty was associated. Illustrations are included for a better understanding of the technique.