title: Supercharged pedicled jejunal interposition for esophageal replacement: a 10-year experience.
abstract: 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.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, and Department of Surgery, The Methodist Hospital, Houston, Texas 77030, USA.
authors.forename: Shanda H
authors.initials: SH
authors.lastname: Blackmon
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Roman
authors.initials: R
authors.lastname: Skoracki
authors.forename: Pierre M
authors.initials: PM
authors.lastname: Chevray
authors.forename: Min P
authors.initials: MP
authors.lastname: Kim
authors.forename: Reza J
authors.initials: RJ
authors.lastname: Mehran
authors.forename: David C
authors.initials: DC
authors.lastname: Rice
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Ara A
authors.initials: AA
authors.lastname: Vaporciyan
authors.forename: Peirong
authors.initials: P
authors.lastname: Yu
authors.forename: Garrett L
authors.initials: GL
authors.lastname: Walsh
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D016629:Esophagectomy; D004944:Esophagoplasty / Q000379:methods*; D004947:Esophagus / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005769:Gastrointestinal Motility; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011312:Pressure; D012189:Retrospective Studies; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome