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Supercharged Jejunum Flap for Total Esophageal Reconstruction: Single-Surgeon 3-Year Experience and Outcomes Analysis

Barzin, Ario M.D.; Norton, Jeffrey A. M.D.; Whyte, Richard M.D., M.B.A.; Lee, Gordon K. M.D.

Plastic and Reconstructive Surgery: January 2011 - Volume 127 - Issue 1 - p 173-180
doi: 10.1097/PRS.0b013e3181f95a36
Reconstructive: Head and Neck: Original Articles
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Background: Esophageal reconstruction after total esophagectomy remains a formidable task irrespective of the conduit chosen. Historically, the gastric pull-up and colonic interposition have served as primary choices for such defects. However, where the stomach and colon are unavailable or unsuitable, the jejunum serves as a reliable alternative for the reconstruction of total esophageal defects.

Methods: The authors performed an outcomes analysis of a single surgeon's surgical technique and experience. Patients who received supercharged pedicled jejunum flaps for reconstruction of total esophageal defects over a 3-year period were included in this study. Data were collected prospectively evaluating operative technique, length of hospital stay, operative time, complications, postoperative diet, and quality-of-life outcomes analysis.

Results: Five patients underwent supercharged pedicled jejunal flap surgery during this study period. All flaps had complete viability and no microvascular complications. One patient had a radiographic anastomotic leak detected by barium swallow that was reexplored and closed primarily and reinforced with a pectoralis advancement flap with subsequent resolution. All patients are currently tolerating a regular diet and there are no symptoms of reflux or dumping. No conduit strictures or redundancy has been found to date, and there has been no need for reoperation in the long term.

Conclusions: The supercharged jejunum flap is a reliable alternative to the gastric pull-up and colonic interposition for total esophageal reconstruction. In our experience, the key maneuver in this technique is a substernal tunnel for the jejunal conduit and exposure of recipient vessels and the esophageal stump by means of a manubriectomy, clavicle resection, partial first rib resection and, occasionally, a second rib resection.

CODING PERSPECTIVE FOR THIS ARTICLE IS ON PAGE 180.

Stanford, Calif.

From the Division of Plastic and Reconstructive Surgery and the Departments of General Surgery and Cardiothoracic Surgery, Stanford University Medical Center.

Received for publication May 5, 2010; accepted June 28, 2010.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Gordon K. Lee, M.D., Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, 770 Welch Road, Suite 400, Palo Alto, Calif. 94304, glee@stanford.edu

©2011American Society of Plastic Surgeons