Supercharged pedicled jejunal interposition for esophageal replacement: A 10-year experience

Shanda H. Blackmon, Arlene M. Correa, Roman Skoracki, Pierre M. Chevray, Min P. Kim, Reza J. Mehran, David C. Rice, Jack A. Roth, Stephen G. Swisher, Ara A. Vaporciyan, Peirong Yu, Garrett L. Walsh, Wayne L. Hofstetter

Research output: Contribution to journalArticle

43 Scopus citations

Abstract

Background: Esophageal continuity after esophagectomy can be established without a viable stomach conduit by using the colon or jejunum. The current study evaluated the technical outcomes of the long-segment supercharged jejunal (SPJ) interposition. Methods: A database was developed to capture patient characteristics, operative technique, and outcomes for patients with an SPJ interposition at 2 institutions from 2000 to 2010. A multivariable analysis was performed to determine predictors of leak and graft loss. A selective prospective manometric analysis was performed to describe peristalsis of the SPJ. Results: Of the 60 patients undergoing SPJ reconstruction, 44 (73%) were men, and the median age was 57 years (range, 28 to 76 years). The operation in 23 patients (38%) was performed to reverse esophageal discontinuity, and 57 (95%) patients underwent reconstruction for cancer. Early complications included 18 instances (30%) of pneumonia, 19 anastomotic leaks (32%), and 5 instances of graft loss with diversion (8%). Three patients (5%) died in the hospital or within 30 days. After jejunal reconstruction, 50 patients (83%) were able to return to a regular diet. The 90-day mortality rate was 10% (n = 6). Characteristic postoperative manometric findings included segmental peristalsis, as is typical for in situ jejunum. Median survival was 28 months and the 5-year survival rate was 30%. Conclusions: An SPJ conduit can reestablish or maintain gastrointestinal continuity in high-risk patients when the stomach is unavailable. This is our preferred conduit for reconstruction of the esophagus over the colon.

Original languageEnglish (US)
Pages (from-to)1104-1113
Number of pages10
JournalAnnals of Thoracic Surgery
Volume94
Issue number4
DOIs
StatePublished - Oct 2012

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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