Laparoscopic Harvesting of Jejunal Free Flaps for Esophageal Reconstruction

Abstract

Endoscopic harvest of the jejunum is indicated for the reconstruction of complex defects of the head and neck and specifically the reconstruction of circumferential defects of the esophagus. However, open laparotomies are associated with systemic and local morbidity and are often seen as prohibitively invasive procedures. Laparoscopy for intra-abdominal procedures is a proven technique that yields less morbidity and provides an anatomical exposure similar to that of the open approach. We report on 11 consecutive clinical cases of free jejunal flap harvesting with the laparoscopic technique and show that the procedure is feasible.

Free jejunal flap transfer with multiple vascular pedicles for safe and reliable pharyngoesophageal reconstruction

“…42 However, it took 3 hours, on average, in that study to harvest jejunal flaps, even with a single pedicle. 42 However, it took 3 hours, on average, in that study to harvest jejunal flaps, even with a single pedicle.…”

“…A previous report of laparoscopic harvest of jejunal flaps suggested that it was less invasive than the regular open laparotomy harvest. 42 However, it took 3 hours, on average, in that study to harvest jejunal flaps, even with a single pedicle. In our procedure, multiple jejunal vessels and arcade vessels must be dissected, and, therefore, performing our procedure laparoscopically would be too time-consuming.…”

51 Microvascular and Regional Flaps in Head and Neck Reconstruction

“…Traditionally, the flap is harvested through a midline incision. Recently there has been increased interest in laparoscopic flap harvest, 83 which can decrease abdominal pain, recovery time, and morbidity associated with the harvest. Transillumination of the bowel aids in identification of the vascular arcades.…”

Variationsmöglichkeiten der freien autogenen Jejunumtransplantation zur differenzierten Rekonstruktion des Oropharynx

“…Es können bis zu 30 cm lange Jejunumsegmente gehoben werden [9,23], die aus einer Gefäûarkade versorgt werden. Diese Transplantate wurden im vorliegenden Patientengut unter Erhaltung der Gefäûarkaden geteilt, so daû bis zu 3 Darmsegmente für eine Defektdeckung zur Verfügung standen.…”

“…Nach experimentellen Studien bei Schweinen und Hunden [27] haben Gherardini et al [9] ein entsprechendes Verfahren beschrieben und bei 10 Patienten eingesetzt. Nach experimentellen Studien bei Schweinen und Hunden [27] haben Gherardini et al [9] ein entsprechendes Verfahren beschrieben und bei 10 Patienten eingesetzt.…”