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Shanda H. Blackmon, MD, Arlene M

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1 Supercharged Pedicled Jejunal Interposition for Esophageal Replacement: A 10-Year Experience 
Shanda H. Blackmon, MD, Arlene M. Correa, PhD, Roman Skoracki, MD, Pierre M. Chevray, MD, PhD, Min P. Kim, MD, Reza J. Mehran, MD, David C. Rice, MD, Jack A. Roth, MD, Stephen G. Swisher, MD, Ara A. Vaporciyan, MD, Peirong Yu, MD, Garrett L. Walsh, MD, Wayne L. Hofstetter, MD  The Annals of Thoracic Surgery  Volume 94, Issue 4, Pages (October 2012) DOI: /j.athoracsur Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 (A) An illustration and (B) photograph show the mesenteric arcade and identification of mesenteric segments for revascularization. (LIMA = left internal mammary artery; SMA = superior mesenteric artery.) The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 (A) Antecolic and (B) retrocolic routes are shown.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 (A) Retrosternal and (B) and posterior mediastinal routes are shown. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 Hemimanubriectomy and resection of the first rib include (A) placement of the initial incision (dashed line), (B) resection of the head of the clavicle and medial portion of the first rib, and (C) route for placement of the jejunal interposition. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

6 Fig 5 Microvascular anastomosis of the mesenteric artery to the left internal mammary artery (A) is done using an interrupted suturing technique, and anastomosis of the mesenteric vein to the left internal mammary vein (V) is achieved with a coupling device (inset). (SPJ = supercharged jejunal interposition.) The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

7 Fig 6 An indicator flap to monitor the viability of the augmented conduit is shown on the anterior chest wall surface. This is typically amputated 1 week after the operation. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

8 Fig 7 Flow diagram shows the clinical outcomes and diet after supercharged jejunal interposition (SPJ). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

9 Fig 8 Manometric appearance of a patient with a supercharged jejunal interposition. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

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