Esophageal reconstruction can be achieved currently with excellent results. For circumferential defects, free jejunal flaps have led the way in their ability to restore excellent swallowing function with minimal morbidity. Nevertheless, when high pharyngeal defects are encountered, the severe mismatch in flap caliber requires significant modification in the jejunal flap or requires choosing another flap. The ileocolon flap can be used for high pharyngeal defects and can be designed to have a good circumference match at both the pharyngeal and esophageal ends.
From June 2003 to January 2005, five ileocolon flaps were used for esophageal reconstruction with newly designed modifications. Four flaps utilized the ascending colon only, where the ascending colon end was sutured to the pharynx and the proximal end (cecum) was sutured to the esophageal stump. In these cases, the ileal segment was used for voice reconstruction. One of the five flaps was carried out where the ascending colon was sutured to the pharynx and the ileum was sutured to the esophagus, and a valvuloplasty of the ileocecal valve was performed.
All patients achieved neoesophageal patency confirmed with barium swallow and had good swallowing function. One patient had a fistula which resolved using conservative measures. Donor-site morbidity was minimal.
Dealing with the caliber mismatch in esophageal reconstruction remains a challenge. Two different designs of the ileocolon flap were introduced that can potentially solve the issue of mismatched circumferences at the pharyngeal and esophageal ends. Technical details, advantages, and disadvantages were discussed.
