MICROSURGICAL RECONSTRUCTION OF THE DIGESTIVE-TRACT FOLLOWING PHARYNGOLARYNGECTOMY AND TOTAL ESOPHAGECTOMY

Total pharyngoesophageal reconstruction has remained a challenging fie ld in digestive surgery. During the past 3 years, the authors performe d six microsurgical reconstructions of the digestive tract following p haryngolaryngectomy and total esophagectomy due to a multiple cancer o r skip metastasis. Digestive continuity was restored using a combinati on of a pulled-up gastric pedicle and free jejunal transfer in 2 patie nts, and an elongated gastric pedicle with microvascular augmentation in 4 patients. One elongated gastric pedicle developed partial necrosi s, and a free jejunal graft was placed additionally. One patient suffe red from respiratory dysfunction and died 1 month after surgery. Posto perative radiographic examination showed a good swallowing mechanism w ithout reflux and stasis in all patients. Microvascular surgery contri butes to the successful reconstruction of the digestive tract followin g extensive pharyngolaryngoesophagectomy.