104. Amniofix as an Aid for the Esophagojejunal Anastamosis In Supercharged Pedicled Jejunum for Total Esophageal Reconstruction

PURPOSE: The supercharged pedicled jejunum has been shown to provide comparable or superior functional outcomes to other options for total esophageal reconstruction. Common complications following this procedure include anastomotic leaks and dehiscence. Amnio fix is a tissue allograft composed of dehydrated human amnion/chorion membrane (DHACM) which has been shown to upregulate basic fibroblast growth factor (FGF), granulocyte colony-stimulating factor, and placental grown factor by dermal fibroblasts, and aid in chronic wound treatment. No study to date has examined the potential therapeutic efficacy AmnioFix(AF) holds for preventing anastomotic complications METHODS: We conducted a retrospective chart review of patients who underwent supercharged pedicled jejunum flaps for total esophageal defects over a 16-year period at our institution, some of which received AF mesh as reinforcement around the esophagojejunal anastamotic site. RESULTS: A total of 37 patients this procedure, and 9(24.3%) had AF. Average age was 58.0±12.1 and BMI at the time of surgery was 24.3±4.9. Average length of hospital stay was 19.0±14.1 days. Post-operatively, AF patients had significantly less leaks at the esophagojejunal site (1 AF patient vs. 14 non-AF patients, p=0.03) and fistulas (0 AF patients, 6 non-AF patients, p=0.04). Patients with AF (8,88.9%) were significantly more likely to return to solid diets at last follow up than those who did not receive reinforcement(13, 35.1%). Usage of AmnioFix did not significantly impact operative time (455.0±19.1 minutes versus 478±15.7 minutes). Average ischemia time was 64±13.5 minutes. Three patients who initially did not have AmnioFix reinforcement required esophagojejunal revisions where AF was installed, and demonstrated no leaks, fistulas, or evidence of aspiration following AF use. CONCLUSION: Usage of AmnioFix mesh for esophago jejunal anastomosis in the setting of esophageal reconstruction with supercharged jejunal flap demonstrated significantly lower post-operative leaks, and fistulas without significantly extending operative time.