PS01.111: STAGED PEDICLED JEJUNAL TRANSFER AFTER AORTOESOPHAGECTOMY FOR AORTOESOPHAGEAL FISTULA. (14th September 2018)

• Record Type: Journal Article
• Authors: Nakamura, Tetsu; Ishida, Sonoko; Hasegawa, Hiroshi; Yamamoto, Masashi; Kanaji, Shingo; Matsuda, Yoshiko; Yamashita, Kimihiro; Matsuda, Takeru; Oshikiri, Taro; Sumi, Yasuo; Suzuki, Satoshi; Kakeji, Yoshihiro
• Is Part Of: Diseases of the esophagus. Volume 31(2018)Supplement 1
• Page Start: 81
• Page End: 81
• Publication Date: 2018-09-14
• Subjects: Pedicled jejunal transfer -- Aortoesophageal fistula; Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doy089.PS01.111
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: Background: Aortoesophageal fistula(AEF) had been a critical and life-threatening disease. The surgical strategy which consist of aortic graft replacement with omental wrapping, esophagectomy, and staged esophageal reconstruction achieve circulatory recovery, infection control and long term survival. The objective of this study is to evaluate surgical outcomes of pedicled jejunal transfer with microvascular augmentation as esophageal reconstruction for AEF. Methods: 14 patients with aortoesophageal fistula who underwent aortic graft replacement and esophagectomy between 2010 and 2017 at Kobe University Hospital and affiliate hospitals were enrolled in this study. Patient characteristics, operative method and clinical outcomes were obtained by retrospective chart review. Results: All 14 patients underwent aortic graft replacement with omental wrapping, esophagectomy and staged esophageal reconstruction. 10 patients (71.4%) successfully underwent staged esophageal reconstruction of pedicled jejunal transfer with microvascular augmentation and showed no leakage and no graft loss. Median survival time in the patients who underwent esophageal reconstruction was 20.3 months from initial operation. Nine of 10 patients were alive but one patient died of sepsis ten months after esophageal reconstruction. Conclusion: Aortic graft replacement with omental wrapping and esophaegcotomy play crucial role in the treatment of AEF. Omentum is pedicled by right epiploic artery and vein to prepare good blood flow and sufficient volume of omental wraping and, consequently, stomach without right epiploic artery and vein becomes inappropriate for esophageal conduit. Pedicled jejunal transfer with microvascular augmentation contributes good post-operative outcome. The surgical strategy for AEF, which includes aortic graft replacement with omental wrapping, esophagectomy, and staged esophageal reconstruction by pedicled jejunal transfer microvascular augmentation is feasible and promising. Disclosure: All authors have declared no conflicts of interest.