Division of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
Department of Surgery, Ross University School of Medicine, Bridgetown, Barbados.
Ann Thorac Surg. 2022 Oct;114(4):1152-1158. doi: 10.1016/j.athoracsur.2021.08.069. Epub 2021 Oct 12.
Delayed distal esophageal reconstruction with nonsupercharged jejunum is an option when gastric conduit is not available. This study aimed to describe a single-center experience with distal esophageal reconstruction with retrosternal Roux-en-Y esophagojejunostomy (RYEJ) and compare perioperative outcomes with retrosternal gastric pull-up (GP).
An Institutional Review Board-exempt retrospective chart review was conducted of patients who underwent esophagostomy closure by the retrosternal route at the University of Minnesota Medical Center (Minneapolis, MN) from January 2009 to July 2019. Patients with colonic conduits were excluded. The study compared patients with RYEJ with a contemporary cohort of patients who underwent GP. The anatomic criteria for RYEJ were the absence of a gastric conduit and an esophageal remnant that reached the sternomanubrial joint. Patient characteristics, anastomotic leak and stricture rate, postoperative complications, hospital length of stay, 30-day readmission, and 90-day mortality were recorded. Statistical analysis was performed using the Fisher exact test and the Wilcoxon rank-sum test with a significance level at P ≤.05.
A total of 9 patients underwent RYEJ, and 10 patients had GP. Previous esophageal adenocarcinoma was more common in the RYEJ group (n = 5) compared with the GP group (n = 0) (P = .01). Patient demographics and comorbidities were comparable between the groups. No differences were found in all end points, including operating time, estimated blood loss, anastomotic leak or stricture rate, Clavien-Dindo class III to IV complications, hospital length of stay, or mortality.
Retrosternal RYEJ without microvascular augmentation is a safe alternative for esophagostomy closure in patients with adequate esophageal length when the stomach is not available. The nonsupercharged jejunum can safely reach the level of the sternomanubrial joint.
当胃管不可用时，使用非增压空肠进行延迟远端食管重建是一种选择。本研究旨在描述单中心经胸骨后 Roux-en-Y 食管空肠吻合术（RYEJ）进行远端食管重建的经验，并将其与经胸骨后胃拉钩术（GP）的围手术期结果进行比较。
对 2009 年 1 月至 2019 年 7 月期间在明尼苏达大学医学中心（明尼阿波利斯，MN）通过胸骨后入路行食管造口关闭术的患者进行了机构审查委员会豁免的回顾性图表审查。排除了结肠造口术患者。该研究比较了 RYEJ 患者与同期接受 GP 治疗的患者。RYEJ 的解剖标准是不存在胃管和到达胸骨柄联合的食管残端。记录了患者特征、吻合口漏和狭窄率、术后并发症、住院时间、30 天再入院和 90 天死亡率。使用 Fisher 确切检验和 Wilcoxon 秩和检验进行统计分析，显著性水平为 P ≤.05。
共有 9 例患者接受了 RYEJ，10 例患者接受了 GP。与 GP 组（n=0）相比，RYEJ 组（n=5）中更常见的是先前的食管腺癌（P=.01）。两组患者的人口统计学和合并症相似。在所有终点（包括手术时间、估计失血量、吻合口漏或狭窄率、Clavien-Dindo Ⅲ-Ⅳ级并发症、住院时间或死亡率）方面均未发现差异。
当胃不可用时，对于食管长度足够的患者，在胸骨后不进行微血管增强的 RYEJ 是关闭食管造口术的一种安全替代方法。非增压空肠可以安全到达胸骨柄联合水平。
