Long-segment supercharged jejunal interposition for salvage oesophageal reconstruction: A complex case

Abstract

Jejunal interposition is an established but infrequently performed option for oesophageal reconstruction, typically reserved for cases where gastric or colonic conduits are unavailable or unsuitable. Microvascular “supercharging” enhances perfusion and permits longer conduit length, expanding its applicability in complex salvage settings. We report a multi-level difficult case of a 71-year-old man who underwent supercharged jejunal interposition one year after failed 2 stage oesophagectomy complicated by anastomotic leak and tracheoesophageal fistula requiring conduit resection and cervical oesophagostomy. Preoperative CT angiography demonstrated concerns regarding colonic marginal arterial perfusion. A substernal jejunal flap based on the second and third arcades was raised with microvascular anastomosis to the transverse cervical artery and internal jugular vein. Postoperative pneumonia, atrial fibrillation, and a delayed cervical leak were managed conservatively. At nine months, the patient tolerated a soft-to-normal diet with stable weight. Supercharged jejunal interposition is a feasible salvage option in selected patients within experienced multidisciplinary centres.