ABSTRACT
The results of reconstruction after total pharyngolaryngectomy using a free revascularized jejunal graft in 72 patients are presented. There was a low hospital mortality (2.8%), a short average time until swallowing (13 days) and a short average postoperative hospital stay (20 days). Twelve patients had resections more extensive than the standard total pharyngolaryngectomy. Sixteen patients (22.2%) suffered some graft complication, but only five (two early graft losses, one late graft loss, one fistula and one stricture) required further reconstructive surgery. Abdominal complications were minimal. There were no complications attributable to post-operative radiotherapy. Swallowing of solids and liquids is good and is maintained long-term. These results are compared with those reported for other methods of reconstruction. This comparison supports a contention that jejunal autograft is the reconstruction of choice after pharyngolaryngectomy.
Subject(s)
Hypopharyngeal Neoplasms/surgery , Jejunum/transplantation , Larynx/surgery , Pharyngeal Neoplasms/surgery , Pharynx/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle AgedABSTRACT
The function of an autotransplanted jejunal graft used to reconstruct the pharyngoesophagus was evaluated in 12 patients, 2-40 mo after surgery. On clinical assessment most patients swallowed liquids and solids with minimal difficulty, although several described a need for liquids to "flush" solids to the stomach. Radiologic studies demonstrated a delay in orogastric transit in some patients above the lower anastomosis. The mechanism was apparent on motility studies: swallows generally failed to induce contractions in the graft, although the esophagus below exhibited stripping peristaltic waves. Regular contractile activity, characteristic of phase III of the intestinal migrating motor complex, was identified in 11 grafts. There was no temporal association between migrating motor complexes in the graft and those recorded at the jejunal donor site. Instillation of nutrients into the gastric antrum induced a typical "fed" pattern of contractions in the intact jejunum but not in the extrinsically denervated graft. In conclusion, the graft provides a useful, though generally passive conduit. The graft maintains its intrinsic motor repertoire, which is asynchronous with that of the donor site. The findings also support the hypothesis that extrinsic nerves are required to induce a "fed" pattern of intestinal motility.
Subject(s)
Esophagus/surgery , Jejunum/transplantation , Aged , Deglutition , Esophagus/diagnostic imaging , Esophagus/physiopathology , Female , Follow-Up Studies , Humans , Jejunum/diagnostic imaging , Jejunum/physiopathology , Laryngectomy , Male , Manometry/methods , Middle Aged , Peristalsis , Pharyngectomy , Postoperative Care , Radiography , Time FactorsSubject(s)
Ear Diseases/epidemiology , Native Hawaiian or Other Pacific Islander , Acoustic Impedance Tests , Adolescent , Audiometry , Australia , Child , Child, Preschool , Cross-Sectional Studies , Ear Diseases/physiopathology , Female , Hearing Disorders/epidemiology , Humans , Longitudinal Studies , Male , SeasonsABSTRACT
Fifty-two patients who underwent reconstruction of the pharynx and esophagus using the free jejunal graft were retrospectively reviewed. The complications were categorized into those associated with the resection, those associated with the harvesting of the graft, and those related to the reconstruction per se. In this series, the graft failure rate was 7.6% with an overall success rate of 90.3%. Graft necrosis was found to be the most serious complication occurring in four patients. Methods of detection of graft necrosis and management of these complications are discussed.
