Hypoparathyroidism following total laryngopharyngectomy and gastric pull-up

We have used the gastric pull-up technique for closure of large pharyngoesophageal defects after radical oncological surgery since 1979. The management of severe hypocalcemia and hypovitaminosis D seemed more difficult in patients undergoing pull-up reconstruction than in patients undergoing the same extirpative surgery, but reconstructed with more traditional methods. To determine if hypocalcemia and hypovitaminosis D were more common in gastric pull-up patients, and if postoperative management of these conditions is more problematic in this group, we retrospectively compared three groups of head and neck surgery patients. Group 1 consisted of 17 patients undergoing total laryngectomy with thyroid complex preservation. Group 2 consisted of 7 patients undergoing mediastinal dissection with total laryngectomy-thyroidectomy previously or concurrently. Group 3 consisted of 30 patients undergoing total laryngopharyngoesophagectomy-thyroidectomy and gastric pull-up reconstruction. The incidences of hypocalcemia requiring therapy were 12%, 50%, and 73%, respectively, with an overall incidence of 51%. The average amounts of supplemental calcium and vitamin D in the three groups were compared. A significant between the three groups was noted. Finally, the dietary calcium and vitamin D requirements for one problematic patient were prospectively recorded and summarized graphically. We conclude that any patient should be carefully monitored for the signs and symptoms of hypocalcemia after major head and neck surgery. In the special instance of the gastric pull-up patient, calcium requirements and the range of serum calcium fluctuation are greatly increased compared to patients undergoing more traditional methods of reconstruction.