[Last recourse reconstruction of the cervicothoracic esophagus: the free jejunal transplant]

Free intestinal autograft has been recommended for oesophageal reconstruction following total circular pharyngolaryngectomy for cancer. Coloplasty or gastroplasty are commonly used for reconstruction of cervical and thoracic oesophagus. Necrosis of the plasty or anastomotic leakage can occur and may require the resection or reintegration of the pedicled graft into the abdominal cavity. For later reconstruction another pedicled graft may not be feasible and interposition of a free intestinal autograft can be a helpful method. The authors report a case of successful reconstruction of the cervical and thoracic oesophagus by a free ileal autograft, after the initial failure of a right coloplasty in a patient with previous gastrectomy. The free ileal autograft was interposed between the cervical oesophagus and the previous coloplasty repositioned in the lower part of the anterior mediastinum. The vessels of the graft were implanted onto the left common carotid artery and the innominate venous confluent.