title: Free jejunal graft for esophageal reconstruction using end-to-side vascular anastomosis and extended pharyngo-jejunostomy.
abstract: BACKGROUND
  Pharyngo-esophageal reconstruction using free jejunal grafts (FJGs) has been widely used, but the procedure is technically demanding and requires the involvement of multiple departments. We performed simplified reconstruction with FJGs using end-to-side vascular anastomosis and extended pharyngo-jejunostomy.
  
  
  METHODS
  The jejunal artery and vein were anastomosed to the neck vessels in an end-to-side fashion without microvascular anastomosis. Pharyngo-jejunostomy with extended end-to-end anastomosis was performed to reduce size mismatch. We retrospectively analyzed the medical records of 32 patients diagnosed with pharyngeal, esophageal, or pyriform sinus cancer who received a FJG.
  
  
  RESULTS
  The mean age was 61.5±9.4 years, and there were 25 male patients. Jejunal vessels were commonly anastomosed to the right common carotid artery and the right internal jugular vein (22, 68.8%). The mean ischemic times of the FJG and carotid artery clamping time were 46.5±8.1 and 15.8±4.4 minutes, respectively. During the procedure, 3 patients suffered from inadequate reperfusion of the FJG requiring removal of the initial graft and replacement with another FJG. There were no neurologic complications, postoperative deaths, or adverse events directly related to FJG except for leakage of the pharyngo-jejunostomy site in 1 patient, which was primarily repaired. During the follow-up period, 5 patients (15.6%) suffered from dysphagia, but only 3 patients had evidence of anastomotic strictures at the jejuno-esophagostomy site. Thirteen patients (40.6%) received postoperative adjuvant radiotherapy.
  
  
  CONCLUSIONS
  Our technique of FJG with end-to-side vascular anastomosis and extended pharyngo-jejunostomy is simple and safe.
authors.affiliation: Department of Thoracic Surgery, Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea.
authors.forename: Hyun-Sung
authors.initials: HS
authors.lastname: Lee
authors.forename: Seong Yong
authors.initials: SY
authors.lastname: Park
authors.forename: Hee-Jin
authors.initials: HJ
authors.lastname: Jang
authors.forename: Moon Soo
authors.initials: MS
authors.lastname: Kim
authors.forename: Jong Mog
authors.initials: JM
authors.lastname: Lee
authors.forename: Jae Ill
authors.initials: JI
authors.lastname: Zo
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D017536:Carotid Artery, Common / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000098:blood supply*; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery*; D007582:Jejunostomy / Q000379:methods*; D007583:Jejunum / Q000098:blood supply* / Q000637:transplantation*; D007601:Jugular Veins / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010610:Pharyngeal Neoplasms / Q000601:surgery*; D010613:Pharyngostomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D056144:Pyriform Sinus / Q000601:surgery*