Page 56 - Prosthetic voice rehabilitation-5th edition

Compared to a gastric pull-up operation (if a total esophagectomy is not indicated) the jejunum flap has some advantages: no need for esophagectomy, less abdominal trauma, no intra-thoracic trauma, no postoperative dumping syndrome, and primary prosthetic voice rehabilitation is possible. Alternatives are the use of a revascularized tubed radial fore arm flap.62 Another alternative is the free greater curvature gastro-omentum flap (figures below left and right).63,64 If the total laryngopharyngectomy has to be combined with total esophagectomy, reconstruction with a gastric pull-up procedure is our method of choice. A relevant observation in this respect is the improved vocalization by using a greater curvature tube instead of the complete stomach. The left figure below shows an intra-operative picture of the tubed stomach pull-up in the neck and the figures right the postoperative barium swallow; note the excellent diameter of the tube, which is comparable to the normal esophageal diameter. 56