title: Hypopharyngeal reconstruction: a comparison of two alternatives.
abstract: Gastric pull-up or free jejunal interposition was used for reconstruction after total laryngopharyngectomy in 31 patients. Complications and functional outcomes of the two methods are compared. Primary swallowing was achieved in 86% of patients after gastric pull-up and in 82% of patients after jejunal interposition. Patients who underwent jejunal interposition were able to swallow sooner and had a shorter hospital stay than patients who underwent gastric pull-up. Esophageal tumor recurrence after jejunal interposition was not observed. Hepatic failure occurred in two gastric pull-up patients, leading to perioperative death in one. Flap necrosis occurred in two jejunal interposition patients and one gastric pull-up patient. Two additional fistulas occurred in jejunal interposition patients as a result of microvascular complications. Stricture developed in four jejunal interposition patients, requiring revision surgery in two. Minor complications were more common in the gastric pull-up group. Long-term speech and swallowing function are compared. Our current choice of jejunal interposition or gastric pull-up for reconstruction after total laryngopharyngectomy primarily depends on the location of the tumor.
authors.affiliation: Department of Otolaryngology, University of Pittsburgh School of Medicine, Pa.
authors.forename: E J
authors.initials: EJ
authors.lastname: de Vries
authors.forename: D W
authors.initials: DW
authors.lastname: Stein
authors.forename: J T
authors.initials: JT
authors.lastname: Johnson
authors.forename: R L
authors.initials: RL
authors.lastname: Wagner
authors.forename: M A
authors.initials: MA
authors.lastname: Schusterman
authors.forename: E N
authors.initials: EN
authors.lastname: Myers
authors.forename: K
authors.initials: K
authors.lastname: Shestak
authors.forename: N F
authors.initials: NF
authors.lastname: Jones
authors.forename: S
authors.initials: S
authors.lastname: Williams
mesh_terms: D000368:Aged; D003679:Deglutition; D004938:Esophageal Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D007013:Hypopharynx / Q000601:surgery*; D007583:Jejunum / Q000637:transplantation; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy; D008297:Male; D008722:Methods; D008875:Middle Aged; D010610:Pharyngeal Neoplasms / Q000601:surgery; D010611:Pharyngectomy; D011183:Postoperative Complications; D012189:Retrospective Studies; D013060:Speech; D013270:Stomach / Q000601:surgery