Salvage Surgery for Jejunal Necrosis After a Free Jejunal Transfer

Introduction Given the few reports regarding the salvage methods for managing jejunal necrosis, finding candidates for a meta-analysis or systematic review is difficult. Thus, this study aimed to describe the interventions for jejunal necrosis and investigate important points relating to this condit...

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Bibliographic Details
Published in:Annals of surgical oncology 2019-07, Vol.26 (7), p.2122-2126
Main Authors: Onoda, Satoshi, Kinoshita, Masahito
Format: Article
Language:English
Subjects:
Blood circulation
Blood flow
Esophageal Neoplasms - pathology
Esophageal Neoplasms - surgery
Esophagectomy - adverse effects
Fistulae
Humans
Hypopharyngeal Neoplasms - pathology
Hypopharyngeal Neoplasms - surgery
Ischemia
Jejunum
Jejunum - pathology
Jejunum - transplantation
Medicine
Medicine & Public Health
Necrosis
Oncology
Patients
Pharyngectomy - adverse effects
Prognosis
Reconstructive Oncology
Reconstructive Surgical Procedures - methods
Salvage Therapy - methods
Surgery
Surgical Oncology
Systematic review
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Summary:Introduction Given the few reports regarding the salvage methods for managing jejunal necrosis, finding candidates for a meta-analysis or systematic review is difficult. Thus, this study aimed to describe the interventions for jejunal necrosis and investigate important points relating to this condition. Methods The interventions used to treat free jejunal necrosis are external fistula formation with jejunal debridement, secondary reconstruction of the local site, and overall status improvement, and re-free jejunal transfer with removal of the necrotic jejunum. Selecting the optimal procedure for each patient depends on the following factors. First, patients must have a good overall status to be able to endure re-free jejunal transfer, and next, the procedure is also dependent on local factors, including the intensity of the infections of the postoperative wound. Results One of the most common factors of jejunal necrosis is necrosis due to blood flow deficiency of the transferred tissue. However, among jejunal necrotic cases, some patients had no blood circulation disorder. We inferred that a non-occlusive mesenteric ischemia like occurred in the transferred jejunum, and also considered patients’ overall status and necrotic association. Thus, patients who underwent re-free jejunal transfer are at an increased risk of experiencing re-necrosis. Based on these findings, we designed a jejunal necrosis algorithm. Conclusions Early debridement and re-free jejunal transfer are optimal treatment options for patients with early-stage jejunal necrosis. Because re-jejunum transfer is a possible state after necrosis, it was thought that coping was the most important aspect of detection at an early stage.
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-019-07348-1