LAUSR

Dear Sir, The ileocolon flap is a well-known technique used for pharyngoesophageal reconstruction (Perrone et al., 2013). The cecum and part of the ascending colon are used to reconstruct the esophagus, while a segment of the terminal ileum is connected to the trachea, shunting air from the main airway to the neo-esophagus and making it resonate (Lo Torto et al., in press). Traditionally, it is a major procedure requiring a laparotomy and usually a long postoperative hospitalization. The aim of this letter is to report the first laparoscopic harvest of ileocolon flap for pharyngoesophageal reconstruction. Pharyngolaryngectomy with immediate reconstruction using an ileocolon flap was planned for a 57-year-old patient presenting with hypopharyngeal cancer (Figure 1A). The flap harvest was performed laparoscopically through 4 trocars. The intestines were mobilized from the terminal ileum up to the transverse colon. After division of the ileocolic pedicle and the right branch of the middle colic artery, the umbilical port was enlarged to deliver the specimen (Figure 1B). The proximal and distal ends of the flap were divided and intestinal continuity was restored with a functionally end-to-end stapled ileocolonic anastomosis. The recipient vessels for revascularization of the flap were the thoracoacromial artery and cephalic vein, as no other suitable vessels were found in the neck. The flap was inset in an isoperistatltic fashion. The cecum was anastomosed to the pharyngeal stump superiorly, while the asccending colon was anastomosed to the upper end of thoracic esophagus inferiorly. The ileal segment of the flap was then used for voice reconstruction with anastomosis to the side of tracheal stump. The total operative time was six hours including the one hour spent for the laparoscopic harvest of the flap. The postoperative course was uneventful. The patient was discharged at one month after tolerating oral feeding. Voice rehabilitation was initiated at 2 months. No perioperative donor or recipient site complication was noted. While the free ileocolon flap provides simultaneous restoration of speech and swallowing function, the traditional open approach might be associated with high donor site morbidity (Karri et al., 2011). The laparoscopic harvest can be a promising alternative that can avoid a large abdominal wound with its associated potential complications and decrease pain and hospitalization time (Ding et al., 2013). This is very important in this patient group due to their short life expectancy (Beauvillain et al., 1997). Laparoscopic harvesting of ileocolon flap is expected to provide all the advantages of a minimally invasive