title: Dysphagia after an L-shaped reconstruction technique of the free jejunum graft.
abstract: BACKGROUND
  The free jejunum graft is a well-established reconstruction technique after total laryngopharyngectomy. However, besides necrosis of the jejunum graft, the two most important complications are pharyngocutaneous fistula formation and dysphagia due to stricture formation.
  
  
  OBJECTIVE
  This study aims to develop an L-shaped reconstruction technique of the free jejunum graft to decrease pharyngocutaneous fistula formation and long-term stricture formation after total laryngopharyngectomy.
  
  
  METHODS
  An L-shaped side-to-end anastomosis was performed at the proximal end of the jejunum graft in six patients treated for piriform sinus carcinoma. Patient and operation characteristics and follow-up were recorded.
  
  
  RESULTS
  A successful jejunum transfer was performed in all six patients. No pharyngocutaneous fistula or stricture formation occurred during a median follow-up of 23 months (range: 18-30 months). Swallowing rehabilitation started at the median 12th postoperative day (range: 5-150 days). Four patients developed dysphagia at a median of 2 months (range: 1-6 months) after oral intake was started. X-barium swallow revealed a redundant pouch of the transferred jejunum graft, which resulted in compression on the jejunum interposition during swallowing. In three patients, an operation was required to resolve these problems. After the revision operation, no dysphagia occurred during a median follow-up of 12 months (range: 7-13 months).
  
  
  CONCLUSIONS
  Because of dysphagia complaints in the majority of our patients, we cannot recommend the described technique and should find other means to improve direct postoperative results and long-term quality of life in this difficult-to-treat group of patients.
authors.affiliation: Department of Head and Neck surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. s.keereweer@erasmusmc.nl
authors.forename: S
authors.initials: S
authors.lastname: Keereweer
authors.forename: A
authors.initials: A
authors.lastname: Sewnaik
authors.forename: J D F
authors.initials: JD
authors.lastname: Kerrebijn
authors.forename: C A
authors.initials: CA
authors.lastname: Meeuwis
authors.forename: H W
authors.initials: HW
authors.lastname: Tilanus
authors.forename: J H W
authors.initials: JH
authors.lastname: De Wilt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery*; D007583:Jejunum / Q000601:surgery / Q000637:transplantation*; D007825:Laryngectomy / Q000009:adverse effects; D008875:Middle Aged; D010611:Pharyngectomy / Q000009:adverse effects; D011183:Postoperative Complications; D056144:Pyriform Sinus; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome