Long-term outcome and quality of life after supercharged jejunal interposition for oesophageal replacement.
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.
['Baker|Cara R|CR|', 'Forshaw|Matthew J|MJ|', 'Gossage|James A|JA|', 'Ng|R|R|', 'Mason|Robert C|RC|']
D000328:Adult D000368:Aged D000714:Anastomosis, Surgical D004938:Esophageal Neoplasms D016629:Esophagectomy D004947:Esophagus D005260:Female D006551:Hernia, Hiatal D006801:Humans D007583:Jejunum D008297:Male D055806:Microvessels D008875:Middle Aged D009336:Necrosis D011788:Quality of Life D012086:Reoperation D012189:Retrospective Studies D019738:Surgically-Created Structures D011795:Surveys and Questionnaires D016896:Treatment Outcome D014656:Vascular Surgical Procedures
Supercharged jejunal interposition Conduit necrosis Oesophagectomy