title: Outcome of free jejunal transfer using the end-to-side arterial anastomosis technique as a pharyngo-oesophageal substitute: a 15-year experience.
abstract: OBJECTIVE
  Free jejunal transfer (FJT) has been preferentially used for pharyngo-oesophageal reconstruction. The success of FJT typically depends on the security of the vascular anastomoses. Arterial anastomosis is usually performed in an end-to-end fashion, with the exception of cases lacking an adequate donor artery due to radiation therapy or infection. At our institution, end-to-side arterial anastomosis to the common carotid artery has been successfully used in FJT for both primary and secondary cervical pharyngo-oesophageal reconstruction.
  
  
  METHODS
  From 1995 to 2010, 41 FJTs were performed by end-to-side arterial anastomosis in 39 patients. Medical records and the follow-up data were retrospectively reviewed.
  
  
  RESULTS
  Thirty-one patients underwent FJT for cancer, 7 for corrosive injury, and 1 for perforation by a foreign body. The graft survival rate was 90.2% (37 of 41). The jejunal mesenteric artery was anastomosed in an end-to-side manner to the common carotid artery in 39 cases, and to the innominate artery in 2. The mesenteric vein was likewise anastomosed in an end-to-side manner to the internal jugular vein in 36 cases and to the innominate vein in 2. In 3 cases, the mesenteric vein was anastomosed to the external jugular vein in an end-to-end manner. Graft failure occurred in 4 patients due to venous thrombosis (3 cases) or arterial rupture due to uncontrolled infection (1 case). Two of these patients underwent redo FJT, while the remaining two underwent gastric pull-up surgery after removal of the graft.
  
  
  CONCLUSIONS
  FJT is a good option for primary or secondary reconstruction of pharyngo-oesophageal defects. End-to-side arterial anastomoses in FJT can be successfully performed without sacrificing the recipient artery.
authors.affiliation: Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Sung Hwan
authors.initials: SH
authors.lastname: Kim
authors.forename: Hong Kwan
authors.initials: HK
authors.lastname: Kim
authors.forename: Kwhanmien
authors.initials: K
authors.lastname: Kim
authors.forename: Young Mog
authors.initials: YM
authors.lastname: Shim
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods*; D004944:Esophagoplasty / Q000009:adverse effects / Q000379:methods*; D004947:Esophagus / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D007583:Jejunum / Q000601:surgery* / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Free jejunal transfer; Oesophageal reconstruction; Oesophageal surgery; Pharyngo-oesophageal substitute