Pharyngocolonic Anastomosis for Esophageal Reconstruction in Corrosive Esophageal Stricture Yao-Guang Jiang, MD, Yi-Dan Lin, MD, Ru-Wen Wang, MD, Jing-Hai.

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Pharyngocolonic Anastomosis for Esophageal Reconstruction in Corrosive Esophageal Stricture Yao-Guang Jiang, MD, Yi-Dan Lin, MD, Ru-Wen Wang, MD, Jing-Hai Zhou, MD, Tai-Qian Gong, MD, Zheng Ma, MD, Yun-Ping Zhao, MD, Qun-You Tan, MD The Annals of Thoracic Surgery Volume 79, Issue 6, Pages 1890-1894 (June 2005) DOI: 10.1016/j.athoracsur.2004.12.046 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 A picture taken during endoscopy of a female patient suffering corrosive esophageal stricture after a mistaken ingestion of sodium hydroxide. The hypopharynx was badly occluded; even saliva could not pass through it. The Annals of Thoracic Surgery 2005 79, 1890-1894DOI: (10.1016/j.athoracsur.2004.12.046) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Photographs of iodine contrast study of the same patient before and after operation. (A) The diffuse corrosive stricture (left arrow) involved the upper esophagus and hypopharynx, and because of aspiration the left and right main bronchus were shown. (B) For esophageal reconstruction a left long-segment colon was used as a substitute, and the orifice of the pharyngocolonic anastomosis (right arrow) was sufficiently wide for a fluent passage of bolus. The Annals of Thoracic Surgery 2005 79, 1890-1894DOI: (10.1016/j.athoracsur.2004.12.046) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 A cervical incision was made along the anterior border of the left sternocleidomastoid muscle (2) to explore the damaged cervical esophagus (1) and the hypopharynx (4). The thyroid gland (5) and sternocleidomastoid muscle were mobilized and retracted laterally together with the common carotid sheath (3). The damaged esophagus was encircled with a traction tape after blunt dissection of the esophagus extended downward along the prevertebral space and behind the trachea. The Annals of Thoracic Surgery 2005 79, 1890-1894DOI: (10.1016/j.athoracsur.2004.12.046) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Colopharyngeal anastomosis was performed in an end-to-end fashion. A left long-segment colon (1) was used as the substitute. To make the orifice of the anastomosis sufficiently wide, a 1- to 1.5-cm vertical myotomy (2) was cut on the anterior wall of the proximal end of the colon graft to match the size of the defect of the hypopharynx (3). The Annals of Thoracic Surgery 2005 79, 1890-1894DOI: (10.1016/j.athoracsur.2004.12.046) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Colopharyngeal anastomosis was completed using a skill that we called “wide margins, single-layered interrupted suture.” This procedure helped to create a sufficiently wide orifice of the anastomosis. The Annals of Thoracic Surgery 2005 79, 1890-1894DOI: (10.1016/j.athoracsur.2004.12.046) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Decision tree for choosing different organs as an esophageal substitute according to the location of the strictured site on the esophagus. The Annals of Thoracic Surgery 2005 79, 1890-1894DOI: (10.1016/j.athoracsur.2004.12.046) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions