1. Overview Reconstruction after total pharyngolaryngoesophagectomy (PLE) has been one of the most challenging operations for its distance covered, adequate routes selected, maintenance and provision of adequate blood supply to the segment of gut used for the reconstruction. There is a lot of debate surrounding the best method of reconstruction. The ideal reconstructive procedure is a one-stage procedure, with low morbidity and mortality rate, and with rapid restoration of wallowing functions. Various methods of reconstruction have been used after resection of hypopharynx. These reconstructions have included local skin flas, deltopectoral flaps, pectoralis major myocutaneuous flaps, visceral reconstruction with stomach or colon and free tissue autographs utilizing colon, jejunum, antral part of the stomach and tubed radial forearm flaps. In this section, I would like to introduce gastric pull-up and colon interposition for reconstruction after total PLE because myocutaneous flaps and jejunal free graft would be discussed in other sections. 2. Gastric pull-up Gastric pull-up after resection of advanced hypopharyngeal and cervical esophageal lesions was first described in 1960 by Ong and Lee. This method became increasingly used after Le Quesne and Ranger popularized the blunt esophagectomy technique and gastric pull-up in 1962. Gastric transposition is the method of choice in cases when carcinoma of the cervical esophagus extends beyond the jugular notch and in cases of synchronous carcinoma of the esophagus when esophagectomy is mandatory. Advantages of gastric pull-up include a one-stage procedure with one anastomosis and removal of the entire esophagus. Its disadvantages include the morbidity of a combined abdominal, thoracic and cervical operation and frequent gastric reflux. Because of relatively high incidence of leakage, Sagawa et al reported the safety and efficacy of the elongated stomach roll with microvascular anastomosis in 2000. 3. Colon interposition Colon interposition for reconstruction after PLE is favorable only in cases when gastric pull-up cannot be done (previous gastric surgery or poor vascular supply). Whenever possible, left colon is strongly recommended due to sufficient length and much better postoperative functional results. Large series have shown a high morbidity and mortality rate for this procedure compared to gastroplasty or free jejuna graft. This is due in part to the combined thoracic and abdominal approach and the necessity for two abdominal and one cervical anastomoses. 4. Conclusions. Surgical treatment seems to be the appropriate therapeutic choice for the majority of patients with advanced hypopharyngeal carcinoma, providing a definitive palliation of dysphagia and relatively good long term survival. Recently, PLE and free jejunal graft has become the standard technique in patients with small carcinoma. However, when esophagectomy should be peformed gastric pull-up is method of choice. The colon is used only when stomach tissue is not available, that is previous gastric resections, inappropriate blood supply, and synchronous gastric carcinoma.