NONSUPERCHARGED RETROSTERNAL ROUX-EN-Y ESOPHAGOJEJUNOSTOMY FOR DISTAL ESOPHAGEAL RECONSTRUCTION.

Abstract Background Delayed distal esophageal reconstruction with nonsupercharged jejunum is an option when gastric conduit is not available. Our aim is 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). Methods We conducted an IRB-exempt retrospective chart review of patients undergoing esophagostomy closure via retrosternal route at our institution from January 2009 to July 2019. We excluded patients with colonic conduits. We compared patients with RYEJ to a contemporary cohort of GP. The anatomic criteria for RYEJ were absence of a gastric conduit and an esophageal remnant that reached the sternomanubrial joint. We recorded patient characteristics, anastomotic leak and stricture rate, postoperative complications, hospital length of stay, 30-day readmission and 90-day mortality. We performed statistical analysis with Fisher's exact test and Wilcoxon rank-sum test with significance level at p= Results We had a total of 9 patients with RYEJ and 10 patients with GP. Previous esophageal adenocarcinoma was more common in the RYEJ group (n=5) compared to the GP group (n=0), p=0.01. Patient demographics and comorbidities were comparable between groups. We found no differences in all end points including operating time, estimated blood loss, anastomotic leak or stricture rate, Clavien-Dindo class III-IV complications, hospital length of stay or mortality. Conclusions Retrosternal Roux-en-Y esophagojejunostomy 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.