Evolution, lessons learned, and contemporary outcomes of esophageal replacement with jejunum for children
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Read the article on pubmed.ncbi.nlm.nih.gov ↗Article · May 2021 · 1 min read
In brief
In brief
Single-center retrospective study comparing outcomes of jejunal interposition for esophageal replacement in 55 children across two time periods (2010-2019). Contemporary cohort showed significantly shorter hospital stays and ICU duration, with microvascular augmentation associated with zero anastomotic leaks versus 18% without augmentation. Despite complexity requiring potential conduit revisions, 78% of patients achieved predominantly oral feeding at median 1.9-year follow-up.
Written by the GCMD Library team from the article.
Background: The jejunal interposition is our preferred esophageal replacement route when the native esophagus cannot be reconstructed. We report the evolution of our approach and outcomes.
Methods: The study was a single-center retrospective review of children undergoing jejunal interposition for esophageal replacement. Outcomes were compared between historical (2010-2015) and contemporary cohorts (2016-2019).
Results: Fifty-five patients, 58% male, median age 4 years (interquartile range 2.4-8.3), with history of esophageal atresia (87%), caustic (9%) or peptic (4%) injury, underwent a jejunal interposition (historical cohort n = 14; contemporary cohort n = 41). Duration of intubation (11 vs 6 days; P = .01), intensive care unit (22 vs 13 days; P = .03), and hospital stay (50 vs 27 days; P = .004) were shorter in the contemporary cohort. Anastomotic leaks (7% vs 5%; P = .78), anastomotic stricture resection (7% vs 10%; P = .74), and need for reoperation (57% vs 46%; P = .48) were similar between cohorts. Most reoperations were elective conduit revisions. Microvascular augmentation, used in 70% of cases, was associated with 0% anastomotic leaks vs 18% without augmentation; P = .007. With median follow-up of 1.9 years (interquartile range 1.1, 3.8), 78% of patients are predominantly orally fed. Those with preoperative oral intake were more likely to achieve consistent postoperative oral intake (87.5% vs 64%; P = .04).
Conclusion: We have made continuous improvements in our management of patients undergoing a jejunal interposition. Of these, microvascular augmentation was associated with no anastomotic leaks. Despite its complexity and potential need for conduit revision, the jejunal interposition remains our preferred esophageal replacement, given its excellent long-term functional outcomes in these complex children who have often undergone multiple procedures before the jejunal interposition.
DOI: 10.1016/j.surg.2021.01.036