title: Long-term outcome and quality of life after supercharged jejunal interposition for oesophageal replacement.
abstract: BACKGROUND
  The consequences of major conduit necrosis following oesophagectomy are devastating. Jejunal interposition with vascular supercharging is an alternative reconstructive method if colon is unavailable. Aims of this study were to review the long-term outcome and quality of life of patients undergoing this surgery in our tertiary unit.
  
  
  METHODS
  Patients undergoing oesophageal reconstruction with supercharged jejunum were identified and retrospective review of hospital notes performed. Each patient was then interviewed for follow up data and quality of life assessment using the EORTC QLQ-C30 questionnaire.
  
  
  RESULTS
  Six patients (5 men) (median age 59 years (range 34-72) underwent supercharged pedicled jejunal (SPJ) interposition from May 2005-August 2010. Indications for surgery were loss of both gastric and colonic conduits following surgery for oesophageal cancer (n = 4), loss of gastric conduit and previous colectomy (n = 1) and lastly, gastric and colonic infarction in a strangulated paraoesophageal hernia (n = 1). Median time to reconstruction was 12 months [6-15 range]. There were no in-hospital deaths. Median postoperative stay was 46 days [13-118]. Three patients required surgical re-intervention for leak, sepsis and reflux, respectively. Median follow up was 6.5 years [range 7-102 months]. One patient died seven months following surgery due to respiratory complications. On follow up, 5 patients have an enteral diet without supplemental nutrition, maintaining weight and good quality of life scores.
  
  
  CONCLUSIONS
  Supercharged jejunal interposition is a suitable alternative conduit for delayed oesophageal replacement in patients with otherwise limited reconstructive options. Good functional outcomes can be achieved despite formidable technical challenges in this group.
authors: Department of Upper GI Surgery, St Thomas' Hospital, London, UK. Electronic address: carab@doctors.net.uk.
authors: Cara R
authors: CR
authors: Baker
authors: Regional Oesophagogastric Unit, Royal Infirmary, Glasgow, Scotland.
authors: Matthew J
authors: MJ
authors: Forshaw
authors: Department of Upper GI Surgery, St Thomas' Hospital, London, UK.
authors: James A
authors: JA
authors: Gossage
authors: Department of Plastic Surgery, St Thomas' Hospital, London, UK.
authors: R
authors: R
authors: Ng
authors: Department of Upper GI Surgery, St Thomas' Hospital, London, UK. Electronic address: Robert.Mason@gstt.nhs.uk.
authors: Robert C
authors: RC
authors: Mason
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D005260:Female; D006551:Hernia, Hiatal / Q000150:complications / Q000473:pathology / Q000601:surgery; D006801:Humans; D007583:Jejunum / Q000098:blood supply / Q000601:surgery*; D008297:Male; D055806:Microvessels / Q000601:surgery; D008875:Middle Aged; D009336:Necrosis; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D019738:Surgically-Created Structures / Q000098:blood supply* / Q000473:pathology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
keywords: Conduit necrosis; Oesophagectomy; Supercharged jejunal interposition