Jejunum for bridging long-gap esophageal atresia

Exploring pros and cons of bridging long-gap esophageal atresia with an orthotopic jejunal pedicle graft. Retrospective series of 19 patients.

From 1988 through 2005, 19 patients with long-gap esophageal atresia received a jejunal graft. Median age at reconstruction was 76 days. The technique involved an initial right-sided thoracotomy or thoracoscopy to confirm the diagnosis of long-gap esophageal atresia. Through a median laparotomy, a small pediculated jejunal graft was prepared and placed transmesocolically and transhiatally in an orthotopic position in the right chest.

All patients survived and none of the grafts were lost. Four intrathoracic and one intraabdominal leak occurred. One intrathoracic and one intraabdominal leak were surgically repaired. One early distal stenosis was reoperated as well. There were always signs of distal functional subobstruction, responding to dilation in all but one patient. Gastroesophageal reflux was not a problem except for one patient whose distal esophagus was eventually resected because of ongoing distal obstruction with dilation of the graft. Except for one patient, all patients are eating normally and most of them grow well. Respiratory problems were rare. Grafts did not become redundant and retained peristaltic activity.

Orthotopic jejunal pedicle graft reconstruction of the esophagus in children is a demanding operation with considerably early morbidity but good long-term results. It should be part of the pediatric surgical armamentarium for reconstruction of the esophagus.