Abstract
Introduction Several surgical techniques are available for pediatric esophageal reconstruction.
We started to use pedicled jejunum interposition graft (PJIG) because other techniques
had significant long-term complications. In this retrospective study, the indications,
surgical complications, and long-term outcomes were assessed in patients with PJIG.
Materials and Methods With ethical consent, we reviewed the hospital records of 14 patients (7 females)
who from 2005 to 2019 underwent a total of 16 esophageal reconstructions with PJIG.
Results Median age at PJIG was 1.6 (range: 0.2–15) years. Underlying conditions were esophageal
atresia (EA) (n = 11) or native esophagus lost by trauma or infection (n = 3). Eight patients with EA underwent PJIG as primary reconstruction and three as
a rescue operation after complications in primary repair. Significant surgical complications
occurred in 43% of patients. Major reoperations in six (43%) patients included resection
and reanastomosis of strictured proximal PJIG (n = 1) and redo PJIG after failure of the first operation (n = 2). Surgical mortality was nil. After a median follow-up of 6.5 (range: 0.7–14)
years, 13 (93%) patients survived, and 1 died of congenital heart disease. PJIG failed
in three (23%) survivors of whom two underwent graft removal because of life-threatening
aspiration and one did not start oral feeds at all. Ten survivors (77%) have full
enteral feeds. Respiratory function in the survivors is satisfactory. Two patients
have moderate and three mild gastroesophageal reflux symptoms.
Conclusion PJIG was a functional option for a variety of conditions that required esophageal
reconstruction. However, significant early and late complications required major surgical
revisions.
Keywords
esophageal reconstruction - jejunal interposition - surgical complications - long-term
outcomes
