Supercharged jejunal interposition, also referred to as esophageal reconstruction, is a procedure in which part or all of the esophagus is removed and replaced, or rebuilt, using a portion of the small intestine called the jejunum.
The term supercharged refers to a technique called microsurgery that increases the microvascular connections of the newly reconstructed esophagus and the area of the small intestine that was removed. Doing so increases the blood supply to these organs and facilitates healing as well as prevents ischemia (a condition that develops when not enough blood, and therefore not enough oxygen, reaches a certain part of the body).
At MedStar Washington Hospital Center, our thoracic surgeons are experts in complex surgeries used to treat advanced or complicated thoracic disorders. Supercharged jejunal interposition is performed on both children and adults.
Why Supercharged Jejunal Interposition Is Performed
The esophagus is the tube-like structure that connects the mouth and throat to the stomach and transports food and liquids to the stomach. When the structure of the esophagus is affected, part or all of the organ may need to be removed and replaced. Supercharged jejunal interposition is performed to treat the following conditions:
- Esophageal atresia: A disorder present at birth that is characterized by an esophagus that did not properly develop, or that is missing a portion of its structure.
- Tracheoesophageal fistula: In a healthy individual, the esophagus and the trachea are not connected and maintain two separate functions. Tracheoesophageal fistula is a condition in which the esophagus and the trachea (windpipe) are connected in one or more places. This condition can either be congenital (present at birth) or can be acquired later in life as a result of infection or trauma.
- Esophageal cancer: When cancer affects the esophagus, this is referred to as esophageal cancer. When removing the cancerous tissue from the esophagus, the doctor may recommend supercharged jejunal interposition surgery in order to replace the tissue that is removed.
What to Expect During a Supercharged Jejunal Interposition Procedure
A supercharged jejunal (SPJ) interposition procedure is a procedure where a piece of small bowel, the jejunum, is used to connect the esophagus to the stomach or small bowel. The reason why we think the small bowel is better for reconstruction than large bowel is because the caliber of the small bowel is approximately the same as the native esophagus, and we feel that the colon has a tendency to become redundant over years. The SPJ procedure is offered to patients who need their esophagus reconstructed and brought in continuity, but either do not have a stomach to use for reconstruction or a stomach that cannot be used for reconstruction, either prior surgery on stomach or a radiated stomach for example. The procedure is performed under general anesthesia and the operation can take anywhere between 10 to 12 hours to complete. Usually, the plastic and thoracic teams have to come together to perform the surgery, which starts off in the abdomen. The small bowel (jejunum) is prepared and transected and is pulled up behind the sternum (breastbone) and connected to the esophagus in the neck. Part of the collar bone and breastbone have to be removed for successful esophago-jejunal anastomosis, and a micro-vascular anastomosis have to be performed in the neck to increase blood flow to the newly constructed esophagus.
Risks Associated with Supercharged Jejunal Interposition
Supercharged jejunal interposition is considered a major surgery. This is because it requires two large incisions on the body and has various stages. For this reason, the procedure does have significant risks. Some of these risks include:
- Difficulty swallowing
- Difficulty speaking
- Acid reflux
- Leaking where the jejunum was placed in the esophagus
- Damage to organs located in the abdominal region or the lungs during surgery
Benefits of Supercharged Jejunal Interposition
Some transplant or reconstructive surgeries use tissue from external sources, such as a donor. In these cases, the body detects tissue that is not its own and activates an attack by the immune system, meaning patients need to take immunosuppressant medications to prevent this response. During a supercharged jejunal interposition, the tissue used to reconstruct the esophagus comes from the patient’s own body. This means that there is no risk of immune response, or attack, on the reconstructed area.
Additionally, the size and structure of the small intestine is similar to the esophagus and therefore provides better results compared to other tissues, such as the colon or stomach.
The microvascular augmentation of the reconstructed area helps prevent or minimize the risk of a condition called ischemia, which occurs when a certain part of the body does not receive enough blood.
How to Prepare for Supercharged Jejunal Interposition
Prior to supercharged jejunal interposition, the patient may be required to undergo a variety of tests to analyze his/her overall health. Additionally, specific instructions will be given to the patient for the day or week before the procedure. It’s important to discuss all medications with the surgeon. Some medications, such as those that have the tendency to thin the blood, may need to be suspended for a few days before the surgery.
Post Supercharged Jejunal Interposition Treatment
Immediately following the procedure, patients will be moved to the recovery unit and will be monitored for any immediate complications. Patients will have a feeding tube inserted during this time to allow the esophagus to heal. Generally, a two-week hospital stay is required after a supercharged jejunal interposition procedure. Roughly 10 to 14 days after the operation, caregivers will test the integrity of the esophagus by asking patients to drink a barium mixture. If there are no leaks in the esophagus, the feeding tube is removed. Once the feeding tube is removed, patients are required to follow a strict diet, beginning with an all liquid diet, then slowly transitioning to soft foods, and finally, returning to normal eating.
Make an Appointment
For an appointment with a specialist, call 202-877-3627.