Reconstruction of the Cervical Esophagus with a Vascularized Free Intestinal Transplant

Kiyonori Harii

Department of Plastic Surgery, Faculty of Medicine, University of Tokyo

Reconstruction of the cervical esophagus following resection of a cancer in the hypopharynx and cervical esophagus is a challenging problem for surgeons. Vascularized free intestinal transfer has recently come to be recommended as an ideal procedure for immediate reconstruction. The origins of this procedure can be traced back to the pioneering work of Seidenberg et al. in 1959 and Nakayama et al. in 1962, but there have been only a few reports of successful clinical results because of the uncertainty and difficulty involved in the anastomosis of intestinal vessels of less than 3 mm without a microscope. The introduction of microvascular anastomosis resulted in a dramatic revival of this procedure because the anastomosis of intestinal pedicle vessels 2 to 3 mm in diameter is easily and safely accomplished under a microscope. In this paper, the author introduces the technical points important for free intestinal transfer, describing the successful (94.8%) results of his 116 transfers (115 jejunum and one ileum) between January 1981 and December 1989 at the National Cancer Center Hospital and the University of Tokyo.

Key words
esophageal reconstruction, free jejunal transfer, microsurgery

Reprint requests
Kiyonori Harii Department of Plastic Surgery, Faculty of Medicine, University of Tokyo
7-3-1 Hongo, Bunkyoku, Tokyo, 113 JAPAN

Accepted
April 17, 1991

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