Inverted, stapled J-pouch free jejunal transfer for reconstruction of the pharynx and esophagus.

Since the advent of the jejunal free flap in the early 1900s, it has become one of the most effective and widely used methods for reconstruction of circumferential defects of the esophagus, often due to malignant disease. However, as esophageal resections extend further cranially, reconstruction becomes more difficult due to the size discrepancy between the proximal jejunum and the pharygostome. Several authors have described techniques to overcome this problem, although there is, as yet, no consensus on the most effective method. Here we present our experience with an inverted, stapled J-pouch free jejunal transfer, analogous to that used in the ileoanal anastomosis after proctocolectomy for the treatment of ulcerative colitis and familial polyposis coli. In the head and neck, the inverted J-pouch provides several advantages when a resection extends into the pharynx: a closer size match to the large pharyngeal defect, a reservoir to aid swallowing, and increased conduit size proximally to aid gravity-dependent swallowing in the presence of uncoordinated peristalsis and tongue resection. This technique has served as a safe, effective, and rapid operation for this complex reconstructive problem.