Jejunal graft conduits after esophagectomy

Area of Science:

• Gastroenterology
• Surgical Oncology
• Regenerative Medicine

Background:

• The jejunum offers unique advantages for esophageal reconstruction.
• Its abundance, lack of extensive preparation, and disease-free nature make it ideal.
• It possesses similar luminal size and intrinsic peristalsis to the esophagus.

Purpose of the Study:

• To determine the outcomes of jejunal interposition for esophageal replacement.
• To review the literature on jejunal use in esophageal surgery.

Main Methods:

• A comprehensive literature search was conducted.
• Databases searched include MEDLINE, Scopus, EMBASE, Science Direct, and Cochrane Library (1990-2013).
• Abstracts and bibliographies were reviewed for relevant studies.

Main Results:

• 246 abstracts were reviewed, with further article and reference searches performed.
• The literature search confirmed the extensive use of jejunum in esophageal reconstruction.
• Jejunal grafts were utilized as free, pedicled, or combined grafts with acceptable results.

Conclusions:

• Jejunum can replace any segment of the esophagus, from distal to entire length reconstructions.
• Techniques include Merendino procedure, pedicled or free jejunal interposition, and super-charged grafts.
• Jejunal grafts can be used as pedicled, free (requiring microvascular anastomosis), or augmented segments.