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

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

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.