A Revised Method for Pharyngoesophageal Reconstruction Using Free Jejunal Transfer

Abstract

Pharyngoesophageal reconstruction using free jejunal transfer is a reliable procedure, but the achievement of perfect functional results is still challenging. We present a devised method. Jejunoesophageal anastomosis is performed after 2 longitudinal incisions are made at the side corners of the esophageal stump. This maneuver not only enlarges the size of the esophageal stump but also provides a "Z-plasty-like" effect, which reduces the risk of delayed stricture formation. The pharyngojejunal anastomosis is performed in an end-to-end manner. Irrespective of the highest point of the pharyngeal defect, a longitudinal incision is made at the edge of the jejunal graft corresponding to the midpoint of the back wall of the pharyngeal stump. With this concept, considerable longitudinal tension is placed on the posterior side of the jejunal graft, whereas moderate tension is placed on the anterior side of the graft, which prevents the fistula formation that tends to occur in the anterior suture line. Twenty patients underwent the reconstruction using this operative procedure. In all cases, postoperative deglutition was satisfactory without jejunal redundancy or constriction. We believe that our method can be applied in most cases of pharyngoesophageal defects, providing simple and reasonable reconstruction using free jejunal transfer with stable results.

Radiological analysis of swallowing and functional outcomes after hypopharyngo-laryngectomy with reconstruction using a jejunal autograft

“…When implanting the jejunal graft, it seems important to make an effort to insert the graft properly stretched [8]. We believe that our data corroborate this statement.…”

Esophagus and Hypopharyngeal Reconstruction

“…fistula rates are 0 to 32% and a less than 10% failure rate. 2,24,31,32,37,46,49,[52][53][54][55][56][57][58] Free Colon The free colon flap is rarely used for esophageal and hypopharyngeal reconstruction due to the size mismatch between esophagus and colon. The use of free ileocolon for voice restoration is described in the aforementioned article by Chen et al in this issue of the journal.…”

One-Segment Double Vascular Pedicled Free Jejunum Transfer for the Reconstruction of Pharyngoesophageal Defects

“…The pharyngojejunal and jejunoesophageal anastomosis is performed in the end-to-end fashion using a hand-sewn technique. 10 On the other hand, the jejunum is transferred as a patch following the partial hypopharyngectomy (PH). The jejunum is trimmed to adjust its size to the pharyngoesophageal defect (Fig.…”

“…11 After surgery, the patency of the vessels is checked using Doppler ultrasonography more than three times a day for a week. 10 A video-fluorographic study of the reconstructed esophagus is performed on the tenth postoperative day, and a liquid diet is then initiated.…”