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November 1985

Pharyngoesophageal Reconstruction Using Free Jejunal Interposition Grafts

Author Affiliations

From the Divisions of Otolaryngology (Drs Fisher and Cole), and General and Thoracic Surgery (Drs Meyers and Seigler), Department of Surgery, Duke University Medical Center, Durham, NC.

Arch Otolaryngol. 1985;111(11):747-752. doi:10.1001/archotol.1985.00800130079010

• Forty patients underwent pharyngoesophageal reconstruction with a free jejunal interposition graft (FJIG). Three categories of disease were treated: (1) primary upper aerodigestive tract carcinomas, (2) recurrent carcinomas, and (3) benign pharyngoesophageal stenosis. There were no intraoperative graft failures. Postoperative complications included four perioperative deaths, eight late graft failures, three transient fistulas, eight distal graft strictures, one prolonged ileus, two postoperative hematomas, one abdominal wound dehiscence, one abdominal abscess, and one hypoglossal nerve palsy. Of the eight patients with late graft failures, three underwent successful jejunal reimplantation, yielding an overall success rate of 88% (35/40). The advantages of an FJIG are as follows: (1) a single-stage procedure for large defects, (2) a jejunal segment approximately the size of the pharyngoesophagus, (3) tissue that is able to tolerate radiation therapy, (4) maintenance of near-physiologic swallowing mechanism, (5) denervated small-bowel model, (6) excellent palliative procedure, and (7) shortened hospitalization. Disadvantages include (1) microvascular surgical technique, (2) abdominal procedure, and (3) limited esophageal speech.

(Arch Otolaryngol 1985;111:747-752)

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