Background and Objectives: Transmediastinal gastric transposition and pharyngogastric anastomosis is perhaps one of the most widely accepted methods for restoration of the alimentary continuity after pharyngoesophageal resection. The need of neck dissection, mediastinal tracheostomy, and previous radiotherapy may favor exposure and rupture of major vessels. Protection with omentum may prevent this complication. A comprehensive review of omentum flap use in surgery was undertaken. Methods: A modified omentum pedicled flap was used in 6 out of 36 patients submitted to total pharyngolaryngoesophagectomy and gastric transposition (PLE&GT). Results: None of the patients had major vessel rupture as compared with a 13% carotid and innominate artery rupture of a series of 30 patients previously operated on without omentum pedicled flap protection. Conclusions: The omental pedicled flap, performed as described, may provide reliable protection for carotid and innominate artery exposure, adding little time to the procedure. J. Surg. Oncol. 1999;70:181-184. (C) 1999 Wiley-Liss, Inc.703181184