Retrosternal pedicled jejunum interposition: an alternative for reconstruction after total esophago-gastrectomy.

摘要: Objective: If the colon cannot be used for reconstruction after total esophago-gastrectomy, alternatives have to sought. Methods: From 1990 2001, retrosternal jejunum loop interposition was performed in 35 patients (male/female: 29:6; mean age 59.2, range 16–83 years) due cancer 32 cases and esophageal perforation three cases. In all with stomach or colon, respectively, impossible on behalf of underlying histology, previous resection impedient colonic diseases. A jejunal segment abundant arcades chosen, preserving a strong, distal arteriovenous mesenteric pedicle, while 2–3 proximal vessels were severed. The pulled up retrosternally, establishing cervical end-to-side esophagojejunostomy. Roux-en-Y anastomosis done convenient position. Results: Two died perioperatively mediastinitis consecutive multiorgan failure (one Boerhaave’s syndrome, one suicidal ingestion acid). case oral part developed venous congestion replaced by free transplant. perioperative course uneventful. Seventeen are well (1–8.5 years). Sixteen metastatic disease. functional results satisfactory. about 50% recurrent dilatations became necessary anastomotic scars. However, none complained severe dysphagia. Conclusion: diseases, pedicled, is an alternative esophagogastrectomy. q 2002 Elsevier Science B.V. All rights reserved.