title: Management algorithm for failed gastric pull up reconstruction of laryngopharyngectomy defects: case report and review of the literature.
abstract: BACKGROUND
  Gastric pull up remains a popular reconstructive option for pharyngoesophagectomy defects extending to thoracic inlet. Gastric necrosis is a dreaded complication of gastric pull up reconstruction and few studies report on management of this complication. MEDLINE, EMBASE, and Web of Science™ databases were searched for publications in the last 25 years on gastric pull up reconstruction following pharyngoesophagectomy. The rates of complications related to gastropharyngeal anastomosis were extracted, and methods of managing gastric necrosis were noted. Forty seven case series were identified reporting on the use of gastric pull up for reconstruction of pharyngoesophageal defects. Mortality rate varied from 0 to 33 % with a weighted average of 8.6 %. In 39 % of patients, mortality was either caused or directly related to failure of the gastropharyngeal anastomosis. The reported rate of gastric necrosis ranged from 0 to 24 % resulting in a 28 % mortality. Options for managing gastric necrosis included: temporary cervical diversion, free jejunum flap, colonic interposition, tubed radial forearm flap, deltopectoralis and pectoralis myocutaneous flaps.
  
  
  METHODS
  We present the first case of an anterolateral thigh flap rescue of gastric necrosis after gastric pull up reconstruction. The case report is followed by a review of literature on management of gastric pull up failures.
  
  
  CONCLUSIONS
  Based on the extracted information, we propose an algorithm for managing gastric pull up failure following pharyngoesophageal reconstruction.
authors.affiliation: Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital & University of British Columbia, Vancouver, BC, Canada. butskiy.alex@gmail.com.|Gordon & Leslie Diamond Health Care Centre, 4th. Fl. 4299B-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. butskiy.alex@gmail.com.
authors.forename: Oleksandr
authors.identifier: http://orcid.org/0000-0001-5086-3187
authors.initials: O
authors.lastname: Butskiy
authors.affiliation: Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital & University of British Columbia, Vancouver, BC, Canada.
authors.forename: Donald W
authors.initials: DW
authors.lastname: Anderson
authors.affiliation: Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital & University of British Columbia, Vancouver, BC, Canada.
authors.forename: Eitan
authors.initials: E
authors.lastname: Prisman
mesh_terms: D000368:Aged; D000465:Algorithms; D000714:Anastomosis, Surgical; D016629:Esophagectomy / Q000009:adverse effects*; D058752:Free Tissue Flaps; D006801:Humans; D007825:Laryngectomy; D008297:Male; D009333:Neck / Q000601:surgery; D009336:Necrosis / Q000209:etiology; D010610:Pharyngeal Neoplasms / Q000601:surgery; D010611:Pharyngectomy / Q000009:adverse effects*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013270:Stomach / Q000473:pathology / Q000637:transplantation*; D013848:Thigh
keywords: Anterolateral thigh; Gastric pull up; Head and neck cancer; Head and neck reconstruction; Pharyngoesophagectomy