Various methods of reconstruction have been applied after total pharyngo-laryngo- esophagectomy in order to provide the continuity of the gastrointestinal tract. Gastric pull-up technique has recently become more popular because of the lower possibility of stricture and the need for a single anastomosis. This work is a combined effort among surgeons in the General Surgery & Otorhinolaryngology departments in Ain-Shams University Hospitals studying the outcome of this technique after total pharyngo-laryngo-esophagectomy (PLE) in patients with resectable hypopharyngeal (postcricoid) carcinoma. We operated on twelve patients, in the period between August 2003 and April 2007. Oral intake was allowed on the 10th postoperative day following radiological confirmation of anastomotic integrity plus clinical well-being.
Four patients developed anastomotic leak (two major and two subclinical leaks detected radiologically) and postoperative neck hematoma occurred in one patient. Two complained of mild dysphagia due to anastomotic narrowing dilated endoscopically with Savary dilators.
All the surviving patients complained of regurgitation of various severities following the start of oral intake.
Total mortality was 5/12. Two patients succumbed to respiratory failure within 2 weeks of re-do for major leak. One patient re-explored for neck hematoma died following the sudden development of pneumothorax and consequent myocardial infarction and two died from severe electrolyte disturbance and multiorgan failure on 5th and 7th postoperative day, respectively.
Although this reconstruction is not without mortalities and morbidities, we consider it at worse a salvage procedure for already helpless patients.