Anastomosis technique for high pharyngogastrostomy

Pharyngogastric anastomosis, otherwise referred to as the “gastric pull-up” procedure, is the most reliable method of reconstruction after laryngopharyngectomy. We current use a method of gastric to pharyngeal anastomosis that avoids excess tension, and thus decreases the incidence of fistulas and flap failures. With the stomach fully mobilized, the “pull-up” is brought high into the nect using a plastic bag to facilitate delivery via the posterior mediastinum. A curved, U-shaped incision is then made in the fundus of the tongue anteriorly, allowing the posterior nasopharynx to be reached without tension.