Pharyngoesophageal reconstruction with free jejunum or radial forearm flap as diversionary conduit: Functional outcomes of patients with persistent dysphagia and aspiration

Luigi Losco, Dicle Aksoyler, Shih Heng Chen, Alberto Bolletta, Jonathan Velazquez-Mujica, Giuseppe Di Taranto, Federico Lo Torto, Marco Marcasciano, Emanuele Cigna, Hung Chi Chen*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

16 Scopus citations

Abstract

Background: A diversion loop provides an alternative pathway for food intake from the bucco-gingival sulcus into the thoracic esophagus. Therefore, the bolus does not pass via pharynx where choking may occur in case of severe dysphagia. The data about outcomes and complications of the diversionary procedure are short and they refer to small cohort with brief follow-up. Methods: This retrospective study analyzed data of 48 patients, mean aged 34.3 years (range, 22–58 years), undergoing the creation of a diversion loop in two stages. Patients complained of aspiration, choking, and dysphagia. Swallowing disorders were caused by corrosive injury, radiation damage, or neurologic injury, and were investigated through laryngoscopy and esophagography. A diversion loop was created in 45 cases with free jejunal flap and in 3 cases with radial forearm flap. Complications, functional outcomes, and revision rate were reviewed. The mean follow-up was 26.3 months. Results: We reported one failure (2%) and one partial necrosis of the free flaps. The most frequent complication was hematoma (8%). One case of esophagocutaneous fistula (2%) and two cases of stricture (4%) were also observed. Forty-two patients (87%) took all of the daily diet from their mouths through the diversionary conduit. A poor functional outcome was significantly associated with pre-operative radiotherapy (p <.0001). Conclusions: The diversion loop offers an alternative route for alimentation. Patients are freed from their choking obsession; moreover, they are rehabilitated into society without the drawbacks of permanent jejunostomy feeding. The technique was upgraded with caudal marginal mandibulectomy to improve the outcomes. Patients undergoing a diversionary procedure due to radiation damage should be carefully informed about the expected functional results.

Original languageEnglish
Pages (from-to)630-638
Number of pages9
JournalMicrosurgery
Volume40
Issue number6
DOIs
StatePublished - 01 09 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2020 Wiley Periodicals LLC

Fingerprint

Dive into the research topics of 'Pharyngoesophageal reconstruction with free jejunum or radial forearm flap as diversionary conduit: Functional outcomes of patients with persistent dysphagia and aspiration'. Together they form a unique fingerprint.

Cite this