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Supercharged Jejunal Interposition: A Reliable Esophageal Replacement in Pediatric Patients

Firriolo, Joseph M. M.D.; Nuzzi, Laura C. B.A.; Ganske, Ingrid M. M.D., M.P.A.; Hamilton, Thomas E. M.D.; Smithers, C. Jason M.D.; Ganor, Oren M.D.; Upton, Joseph III M.D.; Taghinia, Amir H. M.D., M.P.H., M.B.A.; Jennings, Russell W. M.D.; Labow, Brian I. M.D.

Plastic and Reconstructive Surgery: June 2019 - Volume 143 - Issue 6 - p 1266e-1276e
doi: 10.1097/PRS.0000000000005649
Reconstructive: Head and Neck: Original Articles
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Background: There is no consensus for esophageal reconstruction in the pediatric population. Long defects are commonly repaired with gastric pull-up or colonic interposition; however, jejunal interposition offers several potential advantages in children. One historical concern with jejunal interposition has been the risk of flap infarction following transposition. The use of neck and intrathoracic vessels to “supercharge” the jejunum has been reported in adults. This study reports outcomes of supercharged jejunal interposition in pediatric and young adult patients with long esophageal defects.

Methods: The authors reviewed the medical records of patients who underwent supercharged jejunal interposition for esophageal reconstruction at their institution from 2013 to 2017. The authors collected data pertaining to patient characteristics, operative technique, and postoperative outcomes.

Results: Twenty patients, 10 female and 10 male, aged 1.4 to 23.8 years, underwent esophageal reconstruction with supercharged jejunal interposition and were followed for a median of 1.4 years. Seventeen patients had a primary diagnosis of long-gap esophageal atresia, and three required reconstruction following caustic ingestion. Eighty percent of patients had undergone prior attempts at surgical reconstruction. Postoperatively, all conduits demonstrated coordinated peristalsis, and no flap losses were noted. Major complications occurred in seven patients, stricture dilation was performed in four patients, and there was no mortality.

Conclusions: Jejunal interposition with supercharging can be safely performed for management of long esophageal gaps in the pediatric setting; it is useful where the stomach or colon has been used previously or is unavailable. Long-term outcome studies are required to determine whether jejunal interposition provides a more durable and safe conduit than gastric pull-up or colonic interposition over time.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Boston, Mass.

From the Department of Plastic and Oral Surgery and the Department of Surgery, Boston Children’s Hospital, Harvard Medical School.

Received for publication May 14, 2018; accepted October 18, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Dr. Jennings and Dr. Labow are co–senior authors.

Presented at the 9th Congress of the World Society for Reconstructive Microsurgery, in Seoul, Republic of Korea, June 14 through 17, 2017; the 34th Annual Meeting of the Northeastern Society of Plastic Surgeons, in Newport, Rhode Island, September 8 through 10, 2017; Plastic Surgery The Meeting 2017, Annual Meeting of the American Society of Plastic Surgeons, in Orlando, Florida, October 6 through 10, 2017; and the American College of Surgeons Clinical Congress 2017, in San Diego, California, October 22 through 26, 2017.

Brian I. Labow, M.D., Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, 300 Longwood Avenue, Hunnewell 1, Boston, Mass. 02115, brian.labow@childrens.harvard.edu

Copyright © 2019 by the American Society of Plastic Surgeons