Special therapeutic procedures
The "standard” surgical technique for the cervical esophagus reconstruction includes different types of procedures such as the interposition of pedunculated cutaneous or myocutaneous tubes or the mobilization of the stomach and colon with their corresponding vascular pedicles. The inadequate funcional and esthetic results of other techniques as well as the possibility of avoiding unnecessary aggressive surgery are two strong reasons for the consolidation of an attractive alternative: the interposition of a segment of the small bowel revascularized with microsurgical techniques into cervical vascular structures, this is, an intestinal autotransplant.
This reconstructive technique has been carried out in our Department for more than ten years under the following indications:
- Pharynx and cervical esophagus malignant tumors.
- Reconstruction of benign pharyngeal or cervical esophagus structures in patients in which the larynx is preserved.
- Recovery of prior gastric or colic plastias that are normally located via restrosternal route with a proximal stenotic component from ischemic origin.
The complexity of this procedure comes from the preservation of the graft and the vascular reconstruction. The preservation is carried out with similar procedures to those of the intestinal trasplant from cadaveric donor (preservation solution at 4ºC). Thanks to our clinic and experimental experience in over 18 years in digestive trasplant, we can assure the feasibility of intestinal grafts in preservation periods longer than 3 hours.
On the other hand, this type of graft is possible thanks to the use in vascular reconstrution of sophisticated and essential microsurgical techniques for vessels with the smallest caliber at cervical level.
The functional results obtained are highly satisfactory. The patient recovers total oral intake thanks to a correct swallowing mechanism.