Extensive pharyngo-oesophageal reconstruction using multiple jejunal loops.

Two patients underwent subtotal pharyngo-oesophageal reconstruction using jejunum transferred by means of microvascular anastomosis. In both cases, two sets of vascular anastomoses were required, one in the lower neck and the other at the mid-sternal level. In the first patient, a continuous length of jejunum was employed but this led to great redundancy of the bowel on account of coiling as a result of its mesenteric attachment. In the second case, two isolated loops were employed with minimal redundancy. An anatomical study on three fresh cadavers indicated that the maximum defect which can be bridged by a single loop of jejunum lies between 15 and 20 cm. No particular part of the jejunum or ileum seems particularly advantageous in terms of its ability to span large defects.