When the throat and upper food pipe are removed for cancer, something has to replace them or swallowing is impossible. A segment of small bowel, moved with its own artery and vein and joined under a microscope, makes a tube that is already designed to carry food.
A free jejunum flap replaces the pharynx and upper oesophagus after they have been removed for cancer. A short segment of jejunum is taken with its artery and vein, sewn in as a tube between the throat and the remaining oesophagus, and its vessels joined to neck vessels under a microscope. Most patients swallow again, and voice can be restored with a valve.
Removing the larynx together with the pharynx for advanced cancer leaves a gap in the swallowing tube. The mouth no longer connects to the stomach, and without reconstruction the patient cannot eat at all.
Several tissues can bridge that gap. A tube made from skin works but has to be rolled and sutured along its length, giving a long suture line that can leak. Jejunum arrives as a tube already. It is the right diameter, it is lined with mucosa that expects to be wet and to carry food, and it has a reliable artery and vein in its mesentery that can be joined to the vessels of the neck.
Its own peristalsis is actually a minor nuisance rather than a help, because a short segment contracts out of sequence with swallowing, but in practice most patients swallow well.
The operation is long and involves two surgical fields, the neck and the abdomen. It usually follows radiotherapy, which makes the neck tissues less forgiving and raises the risk of leaks. Voice is dealt with separately, usually with a small valve placed between windpipe and food pipe, which many patients learn to use well.
Fitness for a long operation with two surgical sites, and the state of the neck vessels after radiotherapy, decide this.
The head and neck team removes the tumour with the larynx and pharynx, leaving the defect to be reconstructed.
Suitable artery and vein are identified in the neck. In an irradiated neck this step can be the most difficult part of the operation.
A short segment of small bowel is taken with its artery and vein, and the remaining bowel is joined back together.
The bowel is sewn in with its peristalsis running in the direction of swallowing, joined to the throat above and the oesophagus below.
The artery and vein are joined to the neck vessels under the microscope and flow confirmed.
A small segment of bowel is often left visible at the skin so the flap's circulation can be watched directly in the first days.
Intensive monitoring of the flap. Fed through a tube. Nothing by mouth. Any colour change in the monitoring segment is acted on immediately.
A swallow study checks the joins for leaks before anything is taken by mouth. Once clear, sips and then soft diet begin.
Diet advances with speech and language therapy support. Abdominal wound heals. Voice rehabilitation begins if a valve was placed.
Swallowing continues to improve. Narrowing at a join, if it develops, is managed with dilatation. Cancer surveillance continues.
Most patients return to swallowing, usually starting with soft foods and progressing over weeks, and that is the main aim. Swallowing is rarely identical to before: it can feel slower, and some patients notice mucus production from the bowel lining. Voice is not restored by this operation itself; a valve is needed and learning to use it takes practice. Narrowing at either join is the commonest late problem and is usually managed with dilatation. These are major cancer operations in patients who are often frail, and recovery is measured in months.
This is major surgery with two operative sites, usually in irradiated tissue, and the risks reflect that honestly.
The first days protect the blood supply; the following months rebuild swallowing.
It restores swallowing. Voice after removal of the larynx requires a separate valve, and learning to use it takes practice and support.
Nothing goes by mouth until a swallow study confirms the joins are sealed, usually around a week. Diet then advances gradually from liquids to soft food over weeks.
Only a short segment is taken and the remaining bowel is rejoined. Digestion is generally unaffected.
It is an option, but it has a long suture line along its length which can leak. Jejunum comes as a tube already, which is why it is often preferred for a circumferential defect.
This reconstruction needs microsurgery in a neck that has usually been irradiated, where suitable vessels can be scarce and the margin for error is small. Monitoring the flap closely in the first three days is what allows a failing join to be rescued.
Cancer reconstruction of this kind is commonly covered by health insurance and by government schemes including PM JAY. Cost reflects a long operation, intensive care and a prolonged admission. A written estimate is provided as part of the overall cancer treatment plan.
Almost always about eating and speaking.
Ask your question →Most patients return to swallowing, starting with liquids and progressing to soft and then normal food over several weeks. It is rarely identical to before: it can feel slower, and some people notice extra mucus from the bowel lining.
Not from this operation itself. Where the voice box has been removed, speech is restored with a small valve placed between the windpipe and the food pipe. Many patients learn to use it well, and speech therapy support is part of the plan.
Because jejunum is already a tube of roughly the right size, lined with mucosa suited to carrying food. A tube made from skin needs a long suture line along its length, which is an additional place for a leak to develop.
Only a short segment is used and the remaining bowel is joined back together. Digestion is generally unaffected. The abdominal wound does add to the recovery.
Yes, and that is discussed openly. Irradiated tissue heals less reliably, leaks at the joins are more likely, and finding good vessels in the neck can be harder. It does not prevent the operation, but it changes the risk.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
