Technical challenges of total esophageal reconstruction using a supercharged jejunal flap

Objective: To review our experience and technique of the supercharged jejunal flap for total esophageal reconstruction. Background: A gastric pull-up is the first choice for total esophageal reconstruction. When this fails or when the stomach is unavailable, a supercharged jejunal flap may reestablish alimentary tract continuity. Methods: We performed a retrospective review of 51 patients who underwent a supercharged jejunal flap for total esophageal reconstruction between March 2000 and September 2009 at a single institution. Patient characteristics, technical details, and outcomes were analyzed. Results: Thirty-six men and 15 women patients were included with a mean age of 55 (28-74) years. An immediate reconstruction was performed in 34 (67%) patients and delayed in 17 patients. The jejunal conduit was passed through a substernal route in 31 (60%) patients and a retrocardiac route in 20 patients. Most common recipient arteries were the internal mammary and transverse cervical. 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 2 most frequent. Mean length of hospital stay was 21.5 ± 14.0 days. Forty-four (90%) patients were able to achieve a regular diet and 39 (80%) patients discontinued their tube feeds. Conclusion: This technically challenging operation requires a multidisciplinary approach and careful planning, yet can be successfully performed with good long-term function and acceptable morbidity. An algorithm delineating the operative strategy is presented.