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Eur J Pediatr Surg 2020; 30(01): 111-116
DOI: 10.1055/s-0039-3402713
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Indications, Surgical Complications, and Long-Term Outcomes in Pediatric Esophageal Reconstructions with Pedicled Jejunal Interposition Graft

Antti Koivusalo
1   Department of Pediatric Surgery, Children's Hospital, University of Helsinki, Helsinki, Finland
,
Janne Suominen
1   Department of Pediatric Surgery, Children's Hospital, University of Helsinki, Helsinki, Finland
,
Jukka Salminen
2   Department of Pediatric Cardiac Surgery, Children's Hospital, University of Helsinki, Helsinki, Finland
,
Mikko Pakarinen
1   Department of Pediatric Surgery, Children's Hospital, University of Helsinki, Helsinki, Finland
› Author Affiliations
Further Information

Publication History

13 May 2019

03 December 2019

Publication Date:
01 January 2020 (online)

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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
 

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