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Does Omitting Distal Anastomosis in Hypopharyngeal Defect Reconstruction Improve Dietary Outcomes?

Year: 2026

Type: article

Abstract: OBJECTIVE: Circumferential reconstruction is required for total hypopharyngeal defects to restore swallowing. Reconstructive options differ in conduit biology and anastomotic configuration, particularly the presence of a distal alimentary anastomosis. This study compared postoperative complications, dietary recovery, and survival among three reconstructive strategies. METHODS: This retrospective cohort study included 102 patients who underwent total hypopharyngeal reconstruction between 2015 and 2025 using a free anterolateral thigh (ALT) fasciocutaneous flap (n = 57), gastric pull-up (n = 24), or free ileocolonic flap (n = 21). Postoperative complications, long-term dietary outcomes, and 5-year survival were evaluated. Time to regular diet was analyzed using multivariable Cox proportional hazards models adjusting for age, body mass index, length of hospitalization, and endocrine comorbidities. RESULTS: Baseline characteristics were similar across groups. Early pharyngocutaneous fistulas were most common in the ileocolonic flap group (23.8%), whereas late fistulas occurred mainly after gastric pull-up reconstruction (12.5%). At 3 years, regular diet was achieved by 63.2% of ALT flap patients, compared with 100% of gastric pull-up and 90.5% of ileocolonic flap patients. After adjustment, gastric pull-up (adjusted HR 1.79; 95% CI, 1.05-3.07) and ileocolonic flap reconstruction (adjusted HR 2.00; 95% CI, 1.06-3.79) were independently associated with faster dietary recovery compared with ALT flaps. Five-year survival did not differ significantly among groups. CONCLUSION: Visceral reconstructions yield superior dietary recovery compared with fasciocutaneous flaps for total hypopharyngeal defects. The absence of a distal anastomosis alone did not confer a clear functional benefit, underscoring the importance of conduit biology over anastomotic number.

Source: The Laryngoscope

DOI: 10.1002/lary.70613

Authors: Jian‐Xun Chen, Chia‐Kai Hsu, Shane D. Morrison, Mei‐Chen Lin, Pin‐Keng Shih

Institutions: China Medical University, China Medical University Hospital, University of Washington, University of Washington Medical Center, National Health Research Institutes

Language: English

Topic: Reconstructive Surgery and Microvascular Techniques

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

OpenAlex ID: W7160927146

FWCI:

Cites: 26

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