Free Jejunal Transfer for Reconstruction of Pharyngeal and Cervical Esophageal Defects : Surgical Procedure and Results

Suzuki Toshihiko, Ui Kenji, Shioya Nobuyuki

We report a series of ten patients with carcinoma of the hypopharynx or cervical esophagus, who were treated surgically with reconstruction using free jejunal grafts. The procedure was performed using a team approach, divided into those responsible for resecting the tumor, and those responsible for harvesting the jejunum from the abdomen and performing the microvascular surgery. The pharyngojejunal anastomosis was handsewn in an end-to-side manner with interrupted sutures. The esophagojejunal anastomosis was also performed with a Proximate ILA stapler (ETHICON) in an end-to-end manner. We performed both enteric anastomoses before revascularization. The average period of warm ischemia for the free jejunal graft was 3.8h, but the end result was satisfactory. Early complications with this procedure can include graft failure, usually within the first 72h, and fistula formation. We experienced one case of graft failure among our ten patients due to venous thrombosis, but no other complications. In this patient, a second attempt was made using a free ileal graft, and the graft remained viable. Late complications are characterized by stricture and delayed graft failure. One of our patients, who had developed persistent dysphagia and stenosis, required repeated dilatations which resulted in a symptomatic improvement. Swallowing function in the other patients was satisfactory. We believe that the use of free jejunal graft is the procedure of choice for reconstruction of pharyngeal and cervical esophageal defects.

Free Jejunal Transfer for Reconstruction of Pharyngeal and Cervical Esophageal Defects : Surgical Procedure and Results

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