[Total esophagoplasty using a double pedicled free graft from the jejunum: the last resort]

After repeated failures of classic oesophagoplasties (gastroplasty and coloplasty) a last chance reconstruction could rely on a free jejunal transplant. We report an exceptional and original case where digestive tract was re-established between the orostoma and the epigastric antrum. The patient has four neoplasms in the throat, thoracic oesophagus. After circular pharyngolarynectomy and total oesophagectomy, all the usable vascularized plasties had necrosed. The ultimate reconstruction was performed with a free jejunal transplant carrying two vascular bundles revascularized with the cervical vessels and the internal thoracic vessels. Several recommendations are proposed: Save as much of the digestive tube as possible; preserve the physiological gastroduodenal circuit; redissect the residual plasty in order to raise the new one as high as possible; perform a sub-cutaneous insertion of the residual plasties and the jejunal transplant; and if the loss of digestive substance is greater than 30 cm, a long free jejunal transplant with two vascular bundles should be used.