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Esophageal replacement with jejunum in children: an 18 to 33 year follow-up
Insights
Staged jejunal interposition for esophageal replacement in children shows excellent long-term function. This procedure is safe and reliable, with minimal late complications, making it a viable alternative for esophageal reconstruction.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Esophageal Reconstruction
Background:
- Total esophageal replacement in children is a complex surgical challenge.
- Staged jejunal interposition has been utilized since 1947 for this purpose.
- Long-term functional outcomes of this procedure in pediatric patients require thorough evaluation.
Purpose of the Study:
- To report the late functional results of staged jejunal interposition in children.
- To assess the safety and complication profile of this esophageal replacement technique.
- To evaluate the jejunum as an alternative conduit for esophageal reconstruction in pediatric patients.
Main Methods:
- Retrospective analysis of 32 staged jejunal interpositions performed in children.
- Focus on the first 16 patients who reached adulthood.
- Long-term follow-up including clinical assessment and barium swallow studies.
Main Results:
- 100% long-term follow-up achieved in 16 adult patients (18-33 years post-op).
- Excellent functional outcomes: all patients eat a regular diet; 87% reported no dysphagia.
- Low complication rate: 25% cervical fistulas (healed), 6% cervical stricture (dilated), 6% early graft revision; no late strictures or ulcers.
Conclusions:
- Staged jejunal interposition is a safe and reliable method for total esophageal replacement in children.
- The procedure yields excellent long-term functional results with minimal late complications.
- Jejunal interposition is a recommended alternative to colon and gastric tubes for pediatric esophageal reconstruction.
Abstract:
Since 1947 a total of 32 staged jejunal interpositions have been performed in children for total esophageal replacement. There have been no failures of the jejunum to reach the neck, no loss of graft, and no deaths. The first 16 of these 32 children have now reached adulthood and form the basis for this report on the late functional results of staged jejunal interposition. Among these 16 patients there occurred four cervical fistulas which healed without sequelae (25%), one cervical stricture which necessitated dilatation but not revision (6%), one early cervical revision for necrosis of the distal tip of the graft (6%), and no complications related to the distal anastomosis. Long-term follow-up (range 18 to 33 years; mean 27 years) was obtained in 100% (16/16) of patients. A barium swallow was obtained in 81% (13/16) at a mean of 25 years following initial reconstruction (range 14 to 33 years). The fact that all patients could eat a regular diet at normal speeds indicates satisfactory long-term function. Two patients (13%) reported mild cervical dysphagia. A barium swallow in one of these patients revealed no abnormalities. The other was found to have an apparent esophageal diverticulum which resulted because the jejunum was end-to-side to the esophagus. This was recently corrected 27 years after the initial reconstruction and represented the only late complication of the procedure. There were no late strictures or peptic ulcerations. Motility of the jejunal limb was normal in 12 of the 13 patients studied. These results demonstrate that staged jejunal interposition can be accomplished reliably and safely in children with excellent long-term functional results and a minimum of late complications. The jejunum should be considered as an alternative to colon and gastric tubes for total esophageal replacement in children.