Supercharged pedicled jejunal interposition for esophageal reconstruction: systematic review summary

Authors: Haas EJ, Thurimella K, Baghshomali Y, Egan K, Kaoutzanis C, Irwin T, McCarter M, David EA, Mathes DW, Yu JW

Affiliation: University of Colorado Anschutz School of Medicine

Journal: Journal of Reconstructive Microsurgery, January 2026

PMID: 41534855

Key takeaways

• Adults had substantially higher leak and dysphagia rates than pediatric patients, but also exhibited higher rates of comorbidities.

  • Prior radiation was associated with dumping, stricture, poor wound healing, and reoperation.

• Pediatric cases were longer and associated with longer hospital stays, but major healing-related complications were lower.

Background

Superchargd jejunum is a strong option for esophageal reconstruction when a gastric pull-up is not available because it offers a favorable caliber match and intrinsic peristalsis.

Objective

To compare perioperative characteristics and postoperative complications after SPJ in pediatric versus adult patients and to explore adult comorbid factors associated with complications.

Methods

• PRISMA-guided systematic review and meta-analysis.

• Databases searched: PubMed, Embase, Ovid Medline, and Web of Science.

• Search window: January 2000 to April 2025.

• Included studies: 23.

• Total patients: 477.

  • Adults: 415.

  • Pediatric/young adult: 62.

• Adults were mostly reconstructed for malignancy.

• Pediatric patients were mainly reconstructed for long-gap esophageal atresia.

• Primary endpoint: postoperative complications.

• Additional adult-only exploratory Ridge regression examined study-level comorbid factors associated with complications.

Results

• Mean age: 57.2 years in adults versus 8.0 years in pediatric patients.

• Mean operative time: 667 minutes in adults versus 1,039 minutes in pediatric patients.

• Mean length of stay: 28.0 days in adults versus 51.5 days in pediatric patients.

Primary and notable outcomes

• Anastomotic leak: 18% in adults (73/399) versus 1.7% in pediatric patients (1/58).

• Dysphagia: 34% in adults (28/83 reported) versus 5.6% in pediatric patients (1 reported pediatric patient).

• Pulmonary complications: 32% in adults (117/366) versus 16% in pediatric patients (3/19 reported).

Adult risk-factor signals

• Prior radiation had the strongest association with dumping symptoms.

• Prior radiation was also associated with stricture, poor wound healing, and reoperation.

• Cancer history correlated with leak.

• Prior surgery correlated strongly with surgical-site infection.

• A seemingly protective smoking signal was likely a model artifact rather than a biologically credible finding.

Conclusion

SPJ is a legitimate option for esophageal reconstruction across age groups, but adult and pediatric SPJ are very different clinical scenarios. Adults, who are often reconstructed after cancer, radiation, and prior operations, have more leaks and swallowing problems, while pediatric patients undergo longer and more technically complex operations but generally heal better.

Strengths

• Focus on surgeon-relevant outcomes such as leak, dysphagia, pulmonary complications, and reoperation.

• Attempts to move beyond descriptive pooling by exploring adult risk factors.

Limitations

• Nearly all included studies were retrospective.

• Pediatric patients made up a relatively small share of the total cohort.

• Adult-pediatric comparisons are heavily confounded by indication and are really two very different clinical scenarios.

• Outcome definitions and reporting denominators were inconsistent across studies.

• The regression analysis used aggregate study-level data and should be viewed as hypothesis-generating.

Clinical relevance

For reconstructive microsurgeons, this paper is most useful for preoperative risk framing. Adult SPJ candidates, especially post-cancer and post-radiation salvage patients, should be counseled as high-risk for leak, stricture, dysphagia, wound problems, and reintervention. Pediatric patients represent technically longer cases rather than biologically higher-risk cases. When the stomach is unavailable, jejunum remains a strong conduit option in experienced multidisciplinary centers.

Editorial Notes

• The comparison between adult and pediatric cases is largely irrelevant. Instead, this study serves to highlight the complicated nature of this approach and identifies risk factors for early postoperative complications. 

• Long-term functional outcomes deserve more emphasis, including feeding tube dependence, aspiration risks, dilation burden, and swallowing quality.

• It would be helpful to see stratified analyses by indication, radiation exposure, reconstruction route, and level of anastomosis.