New Options for Aerodigestive Tract Replacement After Extended Pharyngolaryngectomy

Abstract

Objectives: Assess the results of a new type of reconstruction of the aerodigestive tract after extended pharyngolaryngectomy. Study Design: Followup of a total of eight patients who had surgery using ileocolic free graft. Methods: The surgical technique is described. Five patients underwent pharyngolaryngectomy/cervical esophagectomy, and three patients had total laryngectomy with subtotal pharyngectomy. Patients were monitored to assess complications and recovery of satisfactory swallowing and speech. Results: The technique, thanks to the use of material from the colon, proved to be extremely useful for the reconstruction of the digestive tract. At the same time, ileal anastomosis with the tracheal stump enabled aerodigestive crossing restoration, protected by the ileocecal valve. All patients recovered good swallowing capacity and phoniatric expression, which were obtained by digital occlusion of the tracheostomy, forcing the expiratory air through the ileum and ileocecal valve. Manometric tests also showed that after a while there was a gradual synchronization of swallowing between the transplanted colic segment and the residual esophagus. Conclusions: The technique described in the present study may be regarded, also in the light of possible further applications, as a new and interesting option for the reconstruction of the aerodigestive tract.

Modified ileocolic free flap: Viable choice for reconstruction of total laryngopharyngectomy with total glossectomy

“…Currently, there are many techniques that have been described for reconstruction of laryngeal and hypopharyngeal defects 1–5. One interesting technique is the ileocolic free flap, which has been described as a single‐stage operation to achieve all of these objectives 6–9. This technique is not widely used currently; but another visceral flap, the jejunal free flap, is commonly used for circumferential defects of the pharynx and hypopharynx.…”

Voice Reconstruction with Free Ileocolon Flap Transfer: Implications for the Lower Respiratory Tract

“…Although the intrinsic tone and the continence of the valve are not dependent on the integrity of the extrinsic nervous supply, 10 several techniques have been described to increase the competence of the valve following transfer as a free flap: wrapping the anterior and posterior walls of cecum around the terminal ileum, 1 application of Lembert sutures along the ileal tract, 9,11 Volume 127, Number 5 • Ileocolon Flap and Lower Respiratory Tract and the cecum. 5 We started to perform free ileocolon flap surgery for voice reconstruction in 1995.…”

“…5 We started to perform free ileocolon flap surgery for voice reconstruction in 1995. Initially, we applied only subserosal Lembert sutures along the ileal wall to increase the resistance of the conduit and the pressure at the ileocecal junction (as described by others 9,11 ). This alone proved insufficient to avert aspiration.…”

Voice and Swallowing After Laryngopharyngectomy and Free Ileocolic Flap Reconstruction for Hypopharyngeal Cancer

“…When closed, the ileocecal valve protects against aspiration and, when open, permits the passage of air to allow phonation. 9,15,16 One disadvantage of the ileocolic flap is the bowel haustrations, in contrast to the straight, smooth inner surface of the esophagus. The haustral folds of the transferred colon may cause pooling of saliva and stasis of food, delaying its delivery to the distal esophagus (Fig.…”

“…4). 9,15,16 The ileocecal valve is in fact not a true valve; it is merely a sphincter that is normally under autonomic control in the abdomen. This sphincter function may lose after denervation and transfer of the flap, allowing regurgitation of ingested food.…”