Retrosternal pedicled jejunum interposition: an alternative for reconstruction after total esophago-gastrectomy

Abstract

In cases of impedient colonic diseases, the pedicled, retrosternal jejunal loop with cervical anastomosis is an alternative for reconstruction after total esophagogastrectomy.

Esophageal Reconstruction Using a Pedicled Jejunum with Microvascular Augmentation

“…2,5,9,10) Moreover, there was no mortality in patients with microvascular anastomosis, 3,4,6,11,12,[19][20][21][22] whereas the mortality rate was reported to be from 4.1% to 46.6% in patients without microvascular anastomosis.…”

“…An esophago-jejunal or pharyngo-jejunal anastomosis is performed in the neck with circular stapler in an endto-side fashion in Japan, 4,[20][21][22] and hand sewing in an end-to-end fashion in Western countries, 2,3,19) according to the literature. The rate of anastomotic leakage was 13.2% (19/144) using the circular stapler method and 19.4% (14/72) using the manual suturing method, showing no significant difference between the two anastomotic methods (p = 0.229).…”

“…With the recent progress in microsurgery and the recent applications of additional microvascular anastomosis, there were no postoperative deaths or minimal flap loss during the last 20 years, 3,4,6,[19][20][21][22] as shown in Table 1 and described in the paragraph 'Microvascular anastomosis.' Furthermore, Maier et al 2) reported that anastomotic stricture was observed in 4.8% to 18.8% of patients with microvascular anastomosis, 3,[19][20][21][22] compared with 48.6% of cases without microvascular anastomosis.…”

“…The reconstruction of a long distance is not recommended for the pedicled jejunal flap, because severing the continuity of mesenteric arcade is required in order to make a long jejunal flap and straighten it. Nevertheless, the reconstruction with the pedicled jejunum has many advantages compared with pedicled colonic reconstruction, 1) such as the lower rate of flap loss and mortality, fewer anastomosis sites and enterobacteria, a decreased difference from the esophageal diameter, better function of food transit [2][3][4][5][6][7] and a lower incidence of regurgitation, 5) and no significant risk of intrinsic disease such as unexplained massive gastrointestinal hemorrhage or colon carcinoma. 2,3) On the other hand, some advantages of reconstruction with the pedicled colon are the ability to create a long graft, good reservoir function, and prevention of regurgitation by Bauhin's valve in the ileocecal graft.…”

“…However, the stomach cannot be always used as a graft. In patients with a history of partial or total gastrectomy, or who require a gastrectomy due to synchronous double cancer of the stomach or tumor invasion or metastasis into the gastric wall, reconstruction using an organ other than the has been reevaluated, because it is relatively free of intrinsic disease 2,3) and has the advantage of providing active transport of food by peristalsis. [2][3][4][5][6][7] We herein review the progress, outcomes and the functional evaluation of the surgical procedure of jejunal reconstruction, and examined the utility and safety of the method as an alternative to the gastric tube by comparing with the use of jejunal and colonic grafts.…”