title: Supercharged jejunum flap for total esophageal reconstruction: single-surgeon 3-year experience and outcomes analysis.
abstract: 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.
authors.affiliation: Stanford, Calif. From the Division of Plastic and Reconstructive Surgery and the Departments of General Surgery and Cardiothoracic Surgery, Stanford University Medical Center.
authors.forename: Ario
authors.initials: A
authors.lastname: Barzin
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Norton
authors.forename: Richard
authors.initials: R
authors.lastname: Whyte
authors.forename: Gordon K
authors.initials: GK
authors.lastname: Lee
mesh_terms: D000368:Aged; D004032:Diet; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy; D004943:Esophagogastric Junction; D004944:Esophagoplasty / Q000379:methods*; D005260:Female; D018662:Fundoplication; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D013524:Surgical Flaps; D014022:Tissue Survival