Second free jejunum transfer after flap loss does not affect oral intake: A retrospective case-control study

Area of Science:

• Reconstructive Surgery
• Gastrointestinal Surgery
• Oncology

Background:

• Free jejunum transfer is a standard procedure for oral intake restoration after total pharyngo-laryngo-esophagectomy.
• Flap loss necessitating a second free jejunum transfer is a rare but significant event.

Purpose of the Study:

• To investigate the impact of a second free jejunum transfer on post-operative oral intake.
• To compare post-operative outcomes between patients undergoing a first versus a second free jejunum transfer.

Main Methods:

• Retrospective review of 367 patients who underwent free jejunum transfer between July 1998 and December 2019.
• Comparison of dysphagia incidence and post-operative complications between 17 patients requiring a second transfer and 350 patients who did not.
• Estimation of risk factors for dysphagia and complications.

Main Results:

• No statistically significant difference in post-operative dysphagia incidence between the groups.
• A second free jejunum transfer was associated with increased early (2- and 6-month) complications, but not at 12-month follow-up.
• No significant difference in severe complication rates between the groups.

Conclusions:

• A second free jejunum transfer, despite increasing early complications, does not negatively impact long-term oral intake or lead to major complications.
• Free jejunum transfer remains a safe and effective reconstructive option, preserving post-operative quality of life.
• This study supports the continued use of free jejunum transfer in complex head and neck reconstructions.