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Background: Vagal-preserving esophageal resection (VPR) is mostly performed because of high grade dysplasia or intramucosal carcinoma in Barretts esophagus, or in benign end stage complications such as stricture, sigmoid achalasia, epiphrenic diverticulum, perforation, and tumor. Awkward side effects like dumping, diarrhea, and gastritis caused by vagal denervation can usually be avoided by VPR. Although early results of VPR are promising, there are very few studies concerning its long term results.Material and methods: VPR with jejunal or colon interposition with intrathoracic anastomosis was performed in 47 patients between 1994 and 2009. 16 patients (34%) had had 1-2 previous esophageal operations. Follow-up of all patients included periodically endoscopies, barium swallow, esophageal radionuclide transit, scintigraphic measurement of duodeno-gastro-jejunal reflux, pH-monitoring, and manometry.Results: One patient died because of lung embolism (mortality 2%). 12 patients (26%) had postoperative complications: 3 anastomotic leak (all after >10 days), 3 postoperative bleeding with mediastinal hematoma, 3 pneumonia, 1 patchy fundic necrosis, 1 stroke and 1 gynecologic candida-sepsis. Radionuclide transit in the colon interponate was significantly slower than in the jejunal interponate, which on the other hand was significantly slower than that in 10 normal volunteers. 1 patient presented with scintigraphic duodeno-gastric reflux, but no one had scintigraphic reflux into the interponate. 97% of patients operated on, because of complicated GERD, had normal postoperative pH-monitoring. During the follow-up of 1-15 yrs most patients (86%) were generally asymptomatic with good quality of life and normal postoperative endoscopy. 2 patients were treated conservatively because of gastrointestinal hemorrhage (normal interponate). 4 patients had to be reoperated after 4-10 years: 3 resection of the jejunal interponate because of elongation and intussusception causing dysphagia and 1 because of high grade dysplasia in the proximal stomach appearing 6 years after VPR because of earlier esophageal dysplasia.Conclusions: The good objective and subjective short term results of VPR stand the test of time in most patients. In the long term dysphagia may arouse due to elongation and intussusception of jejunal interponate. Therefore, the jejunal interponate should be straight, fixed in the mediastinum, and covered with mediastinal pleura.