Reconstruction of the thoracic esophagus, with extended jejunum used as a substitute, with the aid of microvascular anastomosis.
BACKGROUND
After radical ablation of tumors, colon or jejunum is pulled up for reconstruction of the thoracic esophagus when stomach is unusable. However, esophagocolonic or esophagojejunal anastomotic leak is relatively frequent because of the potential for vascular insufficiency of conduit extended upward.


METHODS
To overcome this disadvantage, 14 consecutive patients with esophageal or gastric carcinomas whose stomachs were unusable were subjected to thoracoesophageal reconstruction through upward extension of the jejunum with microvascular anastomosis. Jejunal vessels were used as graft vessels, and internal thoracic vessels were used as recipient vessels. If needed, arcade vessels were severed to ease extension.


RESULTS
All extended jejunums survived, and there were no operative deaths. Two of four initial series of patients, whose arcade vessels were not severed despite undue tension at the anastomotic site, had esophagojejunal anastomotic leaks that healed spontaneously.


CONCLUSIONS
Some clinical functional problems still exist, but we believe this a safe and useful method for reconstruction of the esophagus where stomach cannot be used.
Hirabayashi
S
S
Department of Surgery, Jichi Medical School, Tochigi, Japan.
Miyata
M
M
Shoji
M
M
Shibusawa
H
H
D000368:Aged; D000714:Anastomosis, Surgical; D004938:Esophageal Neoplasms / Q000601:surgery*; D004944:Esophagoplasty; D004947:Esophagus / Q000098:blood supply*; D005260:Female; D006801:Humans; D007583:Jejunum / Q000098:blood supply* / Q000601:surgery; D046911:Macromolecular Substances; D008297:Male; D008833:Microcirculation / Q000601:surgery*; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery
D046911:Macromolecular Substances