[Circular pharyngo-laryngectomy: reconstruction by free jejunal transplant and vascular microanastomoses in a single stage. 4 cases].
In a certain number of cases, extensive carcinomas of the hypopharynx require total pharyngeal resection, circular, and hence the restoration of continuity by a plastic procedure. Amongst the numerous procedures used (tubular flaps, substitution using a hollow organ), the authors opted for the use of free jejunal transplant with vascular microanastomoses in a single stage. Four cases very different in terms of their indications are reported. The postoperative course was in general very uncomplicated and characterised by the absence of either abdominal or pharyngeal infection. Swallowing became possible on about the 14th day. Vascular permeability was confirmed by arteriography in three cases and was felt to be satisfactory. This is, however, major surgery with a long operation (between 6 and 10 hours) and which at best requires the cooperation of two teams of surgeons. Indications should be considered with caution and in the present study involved only cases of widely extended pharyngeal carcinomas, with the exclusion of oesophageal involvement going beyond the pharyngo-oesophageal sphincter.