Article
Reconstruction of the hypopharynx and cervical esophagus according to the method of Spriano, Piantanida and Pellini
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Authors
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Jobst von Scheel
- HNO-Abt., Asklepios-Klinik St. Georg, Hamburg, Germany
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Wolfgang Teichmann
- 1. Chirurgische Abt., Asklepios-Klinik Altona, Hamburg, Germany
| Published: | September 7, 2006 |
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Outline
Text
Introduction: The most commonly used techniques for reconstruction of the upper digestive tract after laryngopharyngectomy are gastric pull-up or microvascular surgery using jejunum or free skin flaps. The pectoralis major myocutaneous flap has proven to be helpful only after limited resection. However, Fabian [Ref. 1] introduced the myocutaneous flap for reconstruction of the anterior and the lateral walls of the hypopharynx, while the prevertebral fascia was covered by a free skin graft. Spriano et al. modified the method by leaving the prevertebral fascia uncovered [Ref. 2]. It was the aim of our study to evaluate the proposal of Spriano et al..
Methods: The hypopharyngeal tumors of 4 male patients (42-57 years old) were resected by laryngopharyngectomy, including upper parts of the esophagus. The reconstruction was performed according to the proposal of Spriano et al., leaving the prevertebral fascia uncovered.
Results: All patients recovered quickly. The gastric tube was removed after 10-18 days. In one case a salivary fistula and stenosis developed requiring longterm but temporary stenting. One patient suffered a recurrence. Two patients had good swallowing capability, immediately and sustainably (up to more than 2.5 years).
Conclusions: The method of Spriano et al. can be recommended for reconstruction after laryngopharyngectomy. The advantages as compared to gastric pull-up or free tissue transfer are a shorter operating time, a lower complication rate und good functional results. However, if the tumor requires resection of more than 3-5 cm of intrathoracic parts of the esophagus, gastric pull-up should be preferred.
