TECNICAL NOTES   

Minerva Chirurgica 2006 April;61(2):171-5

Copyright © 2006 EDIZIONI MINERVA MEDICA

language: Italian

Laparoscopic harvest of the jejunal free flap for cervical esophageal reconstruction

Bardone M. ¹, Alessiani M. ¹, Zonta S. ¹, Longoni M. ², Faillace G. ², Benazzo M. ³, Occhini A. ³, Dionigi P. ¹

¹ Istituto di Chirurgia Epatopancreatica IRCCS Policlinico S. Matteo Università degli Studi di Pavia, Pavia 2 U.O.C. Chirurgia I Azienda Ospedaliera di Vimercate Presidio Ospedaliero Città di Sesto S. Giovanni, Milano 3 Clinica Otorinolaringoiatrica IRCCS Policlinico S. Matteo Università degli Studi di Pavia, Pavia

The jejunal free flap is a standard technique in the reconstruction of hypopharyngeal and cervical esophageal defects. Conventional harvesting of the jejunal segment is performed with midline open laparotomy, which is associated with complications including prolonged ileus, abdominal pain, wound infection or dehiscence. Laparoscopic resection of the small intestine is a well documented surgical technique. Two different methods of laparoscopic harvest of a jejunal autografts for their cervical implantation have been already described. In both cases, low complication rate and better postoperative course have been observed in the patients treated. During the last 10 years, we have performed 43 circumferential pharyngoesophageal resection for advanced hypo-pharyngeal cancer followed by reconstruction with a free flap of jejunum. All but one the jejunal segments have been harvested with conventional open laparotomy. In the last patient of this group, laparoscopic harvest of the jejunal segment has been successfully performed. In this paper, we describe the laparoscopic technique used and we compare the postoperative course of this patient with those of the patients treated with conventional technique.