Evolution, lessons learned, and contemporary outcomes of esophageal replacement with jejunum for children

Kyle Thompson, Benjamin Zendejas, Wendy Jo Svetanoff, Brian Labow, Amir Taghinia, Oren Ganor, Michael Manfredi, Peter Ngo, C. Jason Smithers, Thomas E. Hamilton, Russell W. Jennings

Research output: Contribution to journalArticlepeer-review


Background: The jejunal interposition is our preferred esophageal replacement route when the native esophagus cannot be reconstructed. We report the evolution of our approach and outcomes. Methods: The study was a single-center retrospective review of children undergoing jejunal interposition for esophageal replacement. Outcomes were compared between historical (2010–2015) and contemporary cohorts (2016–2019). Results: Fifty-five patients, 58% male, median age 4 years (interquartile range 2.4–8.3), with history of esophageal atresia (87%), caustic (9%) or peptic (4%) injury, underwent a jejunal interposition (historical cohort n = 14; contemporary cohort n = 41). Duration of intubation (11 vs 6 days; P = .01), intensive care unit (22 vs 13 days; P = .03), and hospital stay (50 vs 27 days; P = .004) were shorter in the contemporary cohort. Anastomotic leaks (7% vs 5%; P = .78), anastomotic stricture resection (7% vs 10%; P = .74), and need for reoperation (57% vs 46%; P = .48) were similar between cohorts. Most reoperations were elective conduit revisions. Microvascular augmentation, used in 70% of cases, was associated with 0% anastomotic leaks vs 18% without augmentation; P = .007. With median follow-up of 1.9 years (interquartile range 1.1, 3.8), 78% of patients are predominantly orally fed. Those with preoperative oral intake were more likely to achieve consistent postoperative oral intake (87.5% vs 64%; P = .04). Conclusion: We have made continuous improvements in our management of patients undergoing a jejunal interposition. Of these, microvascular augmentation was associated with no anastomotic leaks. Despite its complexity and potential need for conduit revision, the jejunal interposition remains our preferred esophageal replacement, given its excellent long-term functional outcomes in these complex children who have often undergone multiple procedures before the jejunal interposition.

Original languageEnglish (US)
Pages (from-to)114-125
Number of pages12
JournalSurgery (United States)
Issue number1
StatePublished - Jul 2021
Externally publishedYes

ASJC Scopus subject areas

  • Surgery


Dive into the research topics of 'Evolution, lessons learned, and contemporary outcomes of esophageal replacement with jejunum for children'. Together they form a unique fingerprint.

Cite this