Article

Double vascular pedicled free jejunum transfer for total esophageal reconstruction.

Department of Plastic and Reconstructive Surgery, School of Medicine, Kyorin University, Tokyo, Japan.
Journal of Reconstructive Microsurgery (impact factor: 1.43). 02/2005; 21(1):5-10. DOI:10.1055/s-2005-862772 pp.5-10
Source: PubMed

ABSTRACT A double vascular pedicled free jejunum was transferred in two patients with complete esophageal defect. When the stomach and colon, which are usually employed for esophageal reconstruction, cannot be used due to previous operations or for other reasons, the jejunum is the next alternative. However, pedicled jejunal transposition is limited in length and may not reach a suitable level over the lower cervical esophagus, even if the distal portion is supercharged. Under such circumstances, a long jejunal segment with two vascular pedicles can be transferred as a free flap and used to reconstruct the whole esophagus in one stage. The paper describes two cases and discusses the advantages of double vascular pedicled free jejunum transfer.

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    Article: Total esophago-gastrectomy followed by composite reconstruction with retrosternal pedicled jejunum and antethoracic-free jejunal autograft: a case report.
    Junzo Shimizu, Yoshihiko Arano, Norihiko Ishikawa, Iwao Adachi, Tomomi Murata, Chikako Ikeda, Takaharu Masunaga, Hiroshi Ohtake, Hiroshi Minato
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    ABSTRACT: The patient was a 72-year-old man. He received a detailed gastrointestinal examination because of severe anemia. Early multiple esophageal cancers (affecting 3 sites of the esophagus) and advanced gastric cancer were detected. The patient was scheduled to undergo surgical treatment (esophagectomy and total gastrectomy). This operation would be followed by reconstruction with a pedicled jejunum via the antethoracic route. During the operation, however, the mesentery was found to be thick and short, and the anteroposterior dimension of the patient's body was longer than normal. For these reasons, reconstruction with a pedicled jejunum alone via the antethoracic route was judged to be impossible. We then tried composite reconstruction with a pedicled jejunum and free jejunal autograft via the ante-thoracic route. With this method, the pedicled jejunum was not long enough to allow safe anastomosis of both ends of the intestine. To resolve this difficulty, we raised the pedicled jejunum via the retrosternal route to reduce the needed distance for raising, and the free jejunal autograft before the chest wall was guided to a location behind the sternum at the 3rd intercostal level, followed by anastomosis. In this way, we achieved reconstruction while avoiding tension to the reconstructed intestine. Composite reconstruction using the pedicled jejunum and free jejunal autograft is useful as a means of reconstruction of the esophagus when the stomach affected by disease cannot be used for reconstruction, since this method is expected to reduce the tension to the anastomosed area and ensure good blood supply. Our technique is useful when the intestine to be raised is not long enough for composite reconstruction via the antethoracic route.
    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 03/2009; 15(1):31-7.
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Keywords

circumstances
 
complete esophageal
 
distal portion
 
double vascular pedicled free jejunum
 
double vascular pedicled free jejunum transfer
 
free flap
 
lower cervical esophagus
 
next alternative
 
pedicled jejunal transposition
 
previous operations
 
suitable level
 
whole esophagus
 

Akihiko Takushima