Stripped Mesenteric Flap: A Novel Option for Preventing Anastomotic Leakage in Circumferential Pharyngeal Reconstruction

Abstract

Summary:Reconstruction of a circumferential pharyngeal defect with a free jejunal flap is a well-established procedure. However, anastomotic leakage often occurs, which can lead to abscess formation, pharyngocutaneous fistula formation, and carotid rupture. Previous reports have described covering the anastomotic site with a mesenteric flap to prevent anastomotic leakage. However, the mesentery is covered by a serosal membrane, which interferes with adhesion and vascular communication. Therefore, we stripped off the serosal membrane to accelerate adhesion to the anastomotic site. We retrospectively studied patients who had a history of radiotherapy and who had received a stripped mesenteric flap in a circumferential pharyngeal reconstruction procedure. We collected the following data: operative time, blood loss, postoperative complications, interval to resumption of oral intake, and duration of hospital stay. We obtained data for 11 patients. The jejunal flap failed in one patient because of arterial thrombosis. One of the other 10 patients developed anastomotic leakage caused by congested mucous membrane necrosis. The patient was treated conservatively and showed no clinical symptoms of infection or inflammation. The 9 remaining patients had no anastomotic leakage. In the present series, although anastomotic leakage was observed in one of 10 patients who underwent circumferential pharyngeal reconstruction using a stripped mesenteric flap, the severity of the leakage was minimized.

Machine learning approach to predict tracheal necrosis after total pharyngolaryngectomy

“…Second, we usually use a redundant mesenteric flap of the transferred jejunum to separate the jejunoesophageal anastomosis and the tracheostoma to prevent jejunoesophageal anastomotic leakage secondary to tracheal necrosis. 33,34 Of note, this method was not used in the case shown in Figure 2, as redundant mesentery was unavailable in the patient. Lastly, ointment application can be recommended to keep a tracheostoma in a moist environment, as moist environment enhances angiogenesis compared to dry conditions.…”

“…First, intraoperative perfusion assessment using indocyanine green fluorescence imaging is of use to trim the trachea to the level where good perfusion is confirmed when creating a tracheostoma. Second, we usually use a redundant mesenteric flap of the transferred jejunum to separate the jejunoesophageal anastomosis and the tracheostoma to prevent jejunoesophageal anastomotic leakage secondary to tracheal necrosis 33,34 . Of note, this method was not used in the case shown in Figure 2, as redundant mesentery was unavailable in the patient.…”