The Supercharged Pedicled Jejunal Flap (SPJ) for Total Esophageal Reconstruction: A Retrospective Series of 91 Cases
Ashley C. Mays, MD1, Amy Xue, MD2, Wayne Hofstetter, MD1, Michael Klebuc, MD3, Pierre Chevray, MD3, Edward Chang, MD1, Peirong Yu, MD1, Jesse Selber, MD1.
1MD Anderson Cancer Center, Houston, TX, USA, 2Baylor College of Medicine, Houston, TX, USA, 3Methodist Hospital, Houston, TX, USA.
Purpose: A gastric pull-up is the first choice for total esophageal reconstruction.
When this fails or when the stomach is unavailable, a SPJ is our method of choice to reestablish alimentary tract continuity. We aimed to review our experience and technique of the supercharged pedicled jejunal flap (SPJ) for total esophageal reconstruction.
Methods: We performed a retrospective review of 90 patients who underwent a SPJ for total esophageal reconstruction between 2000 and 2017 at the Texas Medical Center. Patient characteristics, technical details, and outcomes were analyzed.
Results: The mean patient age was 55 (28–74) years. An immediate reconstruction was performed in 67% of patients. The jejunal conduit was passed through a substernal route in 60% and a retrocardiac route in 40% of patients. Most common recipient arteries were the internal mammary and transverse cervical. The most common recipient veins were the internal mammary and internal jugular. The overall success rate was 94% with 3 flap failures. A total of 33 patients experienced 1 or more complications with abdominal wound infection and pulmonary complications being the most frequent. Mean length of hospital stay was 21.5 days. Ninety percent of patients were able to achieve a regular diet and 80% of patients were independent of tube feeds.
Conclusion: The SPJ is a technically challenging operation which requires a multidisciplinary approach. With meticulous planning and technique, good long-term function and acceptable morbidity can be achieved. An algorithm delineating operative strategy is presented.
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