Intraoperative leakage testing in free jejunal transfer for hypopharyngeal reconstruction: Impact on pharyngocutaneous fistula and anastomotic stenosis rates.

Abstract

Intraoperative leakage testing (IOLT) is widely used in gastrointestinal surgery. Its application in free jejunal transfer (FJT) for hypopharyngeal reconstruction remains unexplored. We reviewed 49 consecutive patients who underwent FJT with IOLT between June 2021 and February 2024. IOLT was performed using a bulb syringe to inject saline through one nasal cavity while occluding the contralateral nostril and mouth. Despite the jejunum-oesophageal anastomosis remaining unoccluded, rapid saline injection generated sufficient pressure for effective leak detection. Pharyngocutaneous fistula rate was 4.1% (2/49), with both cases occurring in patients with prior radiotherapy. Anastomotic stenosis developed in 9.5% (4/42), including two cases attributed to local recurrence. Oral intake resumed at a median of 16 days postoperatively, with 88% of patients achieving functional swallowing by six months. Although IOLT demonstrates safety and feasibility as a quality control measure during FJT, further validation through prospective trials is warranted.