[Pharyngoesophageal reconstruction using a vascularized free jejunal graft. Indications--technique and surveillance. Report of 90 cases].

Several procedures have been proposed for pharyngoesophageal reconstruction. The use of a revascularized free jejunal graft currently appears to be a method of choice for anatomical, physiological and technical reasons. The authors currently look back on a series of 90 patients having received a revascularized free jejunal graft between 1978 and 1989 inclusive. The indications predominantly include cancer of the pharynx invading the posterior wall and preserving the cervical esophagus, requiring total circular pharyngolaryngectomy (77 cases). Some benign lesions involve reoperated patients (13 cases). The technique for obtaining the jejunal graft is accurately codified: use of the 3rd jejunal loop in isoperistaltic conditions, refrigeration during the period of ischemia, revascularization by the cervical vessels. If a salvage operation is needed, it is necessary to prepare a saphenous venous graft at the beginning of the operation (3 cases). These grafts must be observed daily. Early negative signs include unexplained epistaxis, blood in the saliva, cervical skin suffering. Emergency fiberscopy must be performed with a bronchoscope or a rhinofiberscope. In case of suffering or necrosis of the graft, the patient must be reoperated immediately and a second free jejunal graft must be placed. The absence of postoperative mortality, low morbidity and good functional results obtained in the series are convincing reasons for using this procedure.