Free jejunal transfer for reconstruction of the laryngopharynx

Reconstruction of the laryngopharynx and cervical esophagus presents difficult problems. We embarked on a program using free jejunal transfer for such reconstruction. Thirty-two patients have been evaluated, with a mean follow-up of 16.7 months. Thirty-four transfers were undertaken--14 as primary repair and 20 after the failure of alternate methods. Twenty-six patients were able to achieve oral feeding. There was one immediate and one delayed failure of the graft. Twelve fistulas developed, seven of which healed spontaneously in less than 2 weeks. Four patients experienced complications related to the microvascular anastomosis which required repair. Six patients had significant dysphagia; four of these had side-to-end distal anastomosis. This technique had been abandoned and improvement resulted. We conclude that free jejunal transfer is an expeditious, safe, and reliable method of reconstruction for patients who require total laryngopharyngectomy.