This chapter discusses the necessity of surgical reconstruction in situations where the oesophagus is damaged or needs removal due to various reasons. It highlights the use of different conduits, including the stomach, colon, and jejunum, for replacing part or the entire oesophagus. Factors such as conduit availability, blood supply, and functional outcomes are crucial considerations in choosing the appropriate conduit. Surgical techniques for preparing and transposing conduits, as well as managing complications like leaks, are detailed. Additionally, advancements in creating artificial oesophagi and the use of neck muscles and biological patches for repair are explored. The chapter emphasizes the importance of careful planning and expertise in achieving successful oesophageal reconstruction outcomes.