BACKGROUND: The voice tube should be as short as possible in order to decrease the effort required for phonation. However, when the tumor ablation was very proximal involving the oropharynx, the isoperistaltic ileocolon will need a long segment of ileum for voice reconstruction. Since the direction of colon is not so important, a reverse design is an alternative method to decrease the length of ileum and hence minimize the effort of the patient while speaking. METHOD: Three patients underwent total pharyngolaryngectomy; and were reconstructed with antiperistaltic colon for the pharyngoesophagus, with a short segment of ileum for voice reconstruction. The ileocecal valve was used to prevent food regurgitation. RESULTS: The swallowing function was not affected and the patients could take semisolid diet. They have longer MPT which implied that less effort was required to make voice. The MPT ranged from 12 to 14 seconds with an average of 13 seconds, in comparison to the average 11 seconds of the group of isoperistaltic ileocolon. CONCLUSION: The advantages of reverse ileocolon are (1) requiring a shorter ileum segment, so that the patients need less effort with longer MPT; (2) better size match between the colon and thoracic esophagus. The preliminary result showed better quality comparing to the isoperistaltic group. However, further evaluation with a larger series should be done in the future.