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The Annals of Thoracic Surgery

Volume 108, Issue 3, September 2019, Pages e217-e219
The Annals of Thoracic Surgery

How to do it
Interposition of Retrosternal Pedicled Jejunum After Hypopharyngolaryngo-Esophagogastrectomy

https://doi.org/10.1016/j.athoracsur.2019.04.059Get rights and content

Reconstruction of the upper gastrointestinal tract presents a surgical challenge after esophagogastrectomy, especially when it includes hypopharyngolaryngectomy. Reconstruction is generally undertaken with interposed colon as a substitute conduit, but it carries several risks. Alternative reconstruction of the foregut with pedicled retrosternal jejunum anastomosed at the level of the base of the tongue is described.

Section snippets

Technique

A 42-year-old man was admitted with signs of severe septic shock 2 hours after accidental ingestion of a large amount of strong alkali. Endoscopy revealed distinct necrosis from the hypopharynx throughout the esophagus and into the stomach, confirmed by emergency laparoscopy. A transhiatal esophagogastrectomy was undertaken with cervical esophagostomy, implantation of a jejunal feeding tube, and tracheotomy.

After prolonged intensive medical care, the postoperative course was uneventful.

Comment

Patients with severe caustic pharyngo-laryngeal strictures after esophagogastrectomy present a therapeutic challenge. Thoracic and general surgeons typically reconstruct the esophagus with interposed pedicled colon or jejunum, but hypopharyngeal and esophageal reconstructions involve plastic and ENT surgeons and may require a different approach.6

Colon interposition is the standard procedure for reconstruction after total esophagogastrectomy.1 However, it entails problems such as the need for at

References (7)

  • T.R. DeMeester et al.

    Indications, surgical technique, and long-term functional results of colon interposition or bypass

    Ann Surg

    (1988)
  • A. Maier et al.

    Retrosternal pedicled jejunum interposition: an alternative for reconstruction after total esophago-gastrectomy

    Eur J Cardiothorac Surg

    (2002)
  • T. Sakamoto et al.

    Ileocolon interposition as a substitute stomach after total or proximal gastrectomy

    Ann Surg

    (1997)
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© 2019 by The Society of Thoracic Surgeons Published by Elsevier