TY - JOUR
T1 - Evolution, lessons learned, and contemporary outcomes of esophageal replacement with jejunum for children
AU - Thompson, Kyle
AU - Zendejas, Benjamin
AU - Svetanoff, Wendy Jo
AU - Labow, Brian
AU - Taghinia, Amir
AU - Ganor, Oren
AU - Manfredi, Michael
AU - Ngo, Peter
AU - Smithers, C. Jason
AU - Hamilton, Thomas E.
AU - Jennings, Russell W.
N1 - Funding Information:
The authors would like to thank all of the faculty and staff who participate in the care of our complex patients needing a jejunal interposition, including but not limited to Dorothy Gallagher, Michelle Walton, Andrew Carleton, Leah Frain, Gary Visner, Carlos Munoz, Jue Wang, Michael Hernandez, Walid Alrayashi, Cornelius Sullivan, Jane Riebold, Kathryn Davidson, Kayla Hernandez, Jessica Yasuda, Shawn Anderson, Sukgi Choi, Reza Rahbar, Karen Watters, Christopher Baird, Julia Thomann, Nicole Palumbo, Rosella Micalizzi, Monica Kleinman, Carole Green, and Robert Shamberger. The care of our patients is truly not possible without such a multidisciplinary team of providers dedicated to the best possible care of these children and their families. Thank you.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/7
Y1 - 2021/7
N2 - 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.
AB - 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.
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U2 - 10.1016/j.surg.2021.01.036
DO - 10.1016/j.surg.2021.01.036
M3 - Article
C2 - 33812755
AN - SCOPUS:85103561051
SN - 0039-6060
VL - 170
SP - 114
EP - 125
JO - Surgery (United States)
JF - Surgery (United States)
IS - 1
ER -