Salvage Surgery for Jejunal Necrosis After a Free Jejunal Transfer.

Abstract

Given the few reports regarding the salvage methods for managing jejunal necrosis, finding candidates for a meta-analysis or systematic review is difficult. Thus, this study aimed to describe the interventions for jejunal necrosis and investigate important points relating to this condition. The interventions used to treat free jejunal necrosis are external fistula formation with jejunal debridement, secondary reconstruction of the local site, and overall status improvement, and re-free jejunal transfer with removal of the necrotic jejunum. Selecting the optimal procedure for each patient depends on the following factors. First, patients must have a good overall status to be able to endure re-free jejunal transfer, and next, the procedure is also dependent on local factors, including the intensity of the infections of the postoperative wound. One of the most common factors of jejunal necrosis is necrosis due to blood flow deficiency of the transferred tissue. However, among jejunal necrotic cases, some patients had no blood circulation disorder. We inferred that a non-occlusive mesenteric ischemia like occurred in the transferred jejunum, and also considered patients' overall status and necrotic association. Thus, patients who underwent re-free jejunal transfer are at an increased risk of experiencing re-necrosis. Based on these findings, we designed a jejunal necrosis algorithm. Early debridement and re-free jejunal transfer are optimal treatment options for patients with early-stage jejunal necrosis. Because re-jejunum transfer is a possible state after necrosis, it was thought that coping was the most important aspect of detection at an early stage.