Kenjiro Ishii1, Yasuhiro Tsubosa1, Junichi Nakao2, Ryoma Haneda1,3, Yoshitaka Ishii2, Eisuke Booka1, Shuhei Mayanagi1, Jun Araki1, Yoshichika Yasunaga2, Masahiro Nakagawa2,4. 1. Division of Esophageal Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan. 2. Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan. 3. Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Hanndayama, Higashi-ku, Hamamatsushi, Shizuoka, 431-3192, Japan. 4. Department of Plastic Reconstructive Surgery, Hamamatsu University School of Medicine, 1-20-1 Hanndayama, Higashi-ku, Hamamatsushi, Shizuoka, 431-3192, Japan.
Abstract
BACKGROUND: Pedicled jejunal flap can be utilized with various tips for esophageal reconstruction in patients with a history of gastrectomy or those who have undergone synchronous esophagogastrectomy. However, the rate of anastomosis leakage is high; therefore, we considered the evaluation of blood flow of the remnant esophagus with indocyanine green in setting the anastomosis site. METHODS: Fifty patients who underwent radical esophagectomy with pedicled jejunal flap between January 2011 and June 2020 were identified. From June 2019, blood flow in the pedicled jejunum and remnant esophagus were evaluated to set the anastomosis site of the latter. Usually, the second and third jejunal vessels are transected, and if the jejunal flap cannot reach to the anastomosis point, we actively transect the marginal vessels to stretch the jejunal flap. Microvascular anastomosis between the jejunal branches and the internal thoracic vessels is usually made, and the anastomosis site is set at the well-stained part of the esophagus. RESULTS: Overall, 39 patients underwent the procedure before June 2019 (Group A), and 11 patients underwent the procedure since June 2019 (Group B). No significant difference was found in the patients' background, type of preoperative therapy, presence or absence of ligation of marginal vessels and two-stage operation between the groups. Group A had 16 cases of anastomosis leakage; B had only 1 case (p < 0.05). There were no cases of pedicled jejunum graft necrosis. CONCLUSION: Assessing remnant esophageal perfusion by indocyanine green imaging in pedicled jejunum reconstruction resulted in a lower anastomotic leak rate.
BACKGROUND: Pedicled jejunal flap can be utilized with various tips for esophageal reconstruction in patients with a history of gastrectomy or those who have undergone synchronous esophagogastrectomy. However, the rate of anastomosis leakage is high; therefore, we considered the evaluation of blood flow of the remnant esophagus with indocyanine green in setting the anastomosis site. METHODS: Fifty patients who underwent radical esophagectomy with pedicled jejunal flap between January 2011 and June 2020 were identified. From June 2019, blood flow in the pedicled jejunum and remnant esophagus were evaluated to set the anastomosis site of the latter. Usually, the second and third jejunal vessels are transected, and if the jejunal flap cannot reach to the anastomosis point, we actively transect the marginal vessels to stretch the jejunal flap. Microvascular anastomosis between the jejunal branches and the internal thoracic vessels is usually made, and the anastomosis site is set at the well-stained part of the esophagus. RESULTS: Overall, 39 patients underwent the procedure before June 2019 (Group A), and 11 patients underwent the procedure since June 2019 (Group B). No significant difference was found in the patients' background, type of preoperative therapy, presence or absence of ligation of marginal vessels and two-stage operation between the groups. Group A had 16 cases of anastomosis leakage; B had only 1 case (p < 0.05). There were no cases of pedicled jejunum graft necrosis. CONCLUSION: Assessing remnant esophageal perfusion by indocyanine green imaging in pedicled jejunum reconstruction resulted in a lower anastomotic leak rate.
Authors: Alfred Maier; H Pinter; F Tomaselli; O Sankin; S Gabor; B Ratzenhofer-Komenda; F M Smolle-Jüttner Journal: Eur J Cardiothorac Surg Date: 2002-11 Impact factor: 4.191
Authors: Anthony J Ascioti; Wayne L Hofstetter; Michael J Miller; David C Rice; Stephen G Swisher; Ara A Vaporciyan; Jack A Roth; J B Putnam; W Roy Smythe; Barry W Feig; Paul F Mansfield; Peter W T Pisters; Marla T Torres; Garrett L Walsh Journal: J Thorac Cardiovasc Surg Date: 2005-10-13 Impact factor: 5.209
Authors: Y Doki; K Okada; H Miyata; M Yamasaki; Y Fujiwara; S Takiguchi; T Yasuda; T Hirao; H Nagano; M Monden Journal: Dis Esophagus Date: 2008 Impact factor: 3.429
Authors: Jörg Zehetner; Steven R DeMeester; Evan T Alicuben; Daniel S Oh; John C Lipham; Jeffrey A Hagen; Tom R DeMeester Journal: Ann Surg Date: 2015-07 Impact factor: 12.969