Free jejunal graft for esophageal reconstruction using end-to-side vascular anastomosis and extended pharyngo-jejunostomy.

Abstract

BACKGROUND:

Pharyngo-esophageal reconstruction using free jejunal grafts (FJGs) has been widely used, but the procedure is technically demanding and requires the involvement of multiple departments. We performed simplified reconstruction with FJGs using end-to-side vascular anastomosis and extended pharyngo-jejunostomy.

METHODS:

The jejunal artery and vein were anastomosed to the neck vessels in an end-to-side fashion without microvascular anastomosis. Pharyngo-jejunostomy with extended end-to-end anastomosis was performed to reduce size mismatch. We retrospectively analyzed the medical records of 32 patients diagnosed with pharyngeal, esophageal, or pyriform sinus cancer who received a FJG.

RESULTS:

The mean age was 61.5±9.4 years, and there were 25 male patients. Jejunal vessels were commonly anastomosed to the right common carotid artery and the right internal jugular vein (22, 68.8%). The mean ischemic times of the FJG and carotid artery clamping time were 46.5±8.1 and 15.8±4.4 minutes, respectively. During the procedure, 3 patients suffered from inadequate reperfusion of the FJG requiring removal of the initial graft and replacement with another FJG. There were no neurologic complications, postoperative deaths, or adverse events directly related to FJG except for leakage of the pharyngo-jejunostomy site in 1 patient, which was primarily repaired. During the follow-up period, 5 patients (15.6%) suffered from dysphagia, but only 3 patients had evidence of anastomotic strictures at the jejuno-esophagostomy site. Thirteen patients (40.6%) received postoperative adjuvant radiotherapy.

CONCLUSIONS:

Our technique of FJG with end-to-side vascular anastomosis and extended pharyngo-jejunostomy is simple and safe.

• Authors: Hyun-Sung Lee, Seong Yong Park, Hee-Jin Jang, Moon Soo Kim, Jong Mog Lee, Jae Ill Zo
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 93 Issue 6 Pg. 1850-4 (Jun 2012) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 22440367 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Anastomosis, Surgical (methods)
• Carotid Artery, Common (surgery)
• Esophageal Neoplasms (surgery)
• Esophagectomy (methods)
• Esophagus (blood supply)
• Female
• Humans
• Hypopharyngeal Neoplasms (surgery)
• Jejunostomy (methods)
• Jejunum (blood supply, transplantation)
• Jugular Veins (surgery)
• Male
• Middle Aged
• Pharyngeal Neoplasms (surgery)
• Pharyngostomy (methods)
• Postoperative Complications (etiology)
• Pyriform Sinus (surgery)