TOTAL ESOPHAGOPLASTY USING A DOUBLE VASCU LARIZED FREE JEJUNAL TRANSPLANT - A LAST CHANCE OPERATION

After repeated failures of classic oesophagoplasties (gastroplasty and coloplasty) a last chance reconstruction could rely on a free jejunal transplant. We report an exceptional and original case where digestiv e tract was re-established between the orostoma and the epigastric ant rum. The patient has four neoplasms in the throat, thoracic oesophagus . After circular pharyngolaryngectomy and total oesophagectomy, all th e usable vascularized plasties had necrosed The ultimate reconstructio n was performed with a free jejunal transplant carrying two vascular b undles revascularized with the cervical vessels and the internal thora cic vessels. Several recommendations are proposed: Save as much of the digestive tube as possible; preserve the physiological gastroduodenal circuit; redissect the residual plasty in order to raise the new one as high as possible; perform a sub-cutaneous insertion of the residual plasties and the jejunal transplant; and if the loss of digestive sub stance is greater than 30 cm, a long free jejunal transplant with two vascular bundles should be used.