Flexing the neck relieves tension on cervical esophageal anastomosis

Abstract

Background: The conventional method of bridging anatomic defects of the upper digestive tract in the neck is by tissue transfer - either gastric or colon pull-through, free jejunal graft, or full-thickness skin flaps. An alternative way of closing such defects is to flex the neck. This moves the remnant proximal esophagus or pharynx a considerable distance downwards - a standard tension-releasing maneuver in tracheal resection and reconstruction. Methods: Neck flexion was used in 7 patients grouped into three separate surgical conditions: A) in two patients after esophagectomy, where the pulled-up stomach would not reach the remnant proximal esophagus or the pharynx; B) in three patients where the defect after removal of the diseased portion of the cervical esophagus measured 4.5, 5.0, and 8.0 cm, respectively; and C) in 2 patients with 4.5- and 1.5-cm long circumferential postoperative esophageal strictures managed by Heineke-Miculicz repair. Results: No postoperative cervical fistulas were seen. One patient, whose 8-cm long cervical esophageal defect had been closed by end-to-end anastomosis, developed a stricture. Conclusion: In special situations, flexing the neck allows for safe anastomosis or closure of esophageal defects in the neck, obviating the need for tissue transfer.