It has been well established that microvascular free jejunal transfer is the method of choice for reconstruction of the hypopharynx and the cervical esophagus. On the other hand, gastric pull-up and colon interposition are the preferred methods for reconstructing the thoracic esophagus. There are rare instances when neither the stomach nor an adequate segment of colon is available to provide appropriate length for a tension-free proximal anastomosis. The purpose of this paper is to illustrate a technique of composite esophageal reconstruction that may be employed when conventional methods are inadequate.

Two cases of composite esophageal reconstruction are reviewed. In these difficult cases, the limited colon segment was used as a pedicle graft to reconstruct the distal, thoracic esophagus while the more proximal reconstruction was composed of a free jejunal transfer. The esophageal reconstruction was simplified by performing the colo-jejunal anastomosis intra-abdominally, prior to division of the jejunal vascular pedicle. This key maneuver eliminates the challenge of performing a retro-sternal, intra-thoracic anastomosis, during the ischemic period. The composite conduit can then be passed through the mediastinum, as a single unit, and the proximal jejunal and vascular anasomoses may then be performed. This approach is a reliable method for restoring esophageal continuity.