Esophagus replacement by free, autologous jejunal mucosa transplantation in long-gap esophageal atresia.
There is apparently no ideal operative technique in the treatment of long-gap esophageal atresia, as is shown by the plurality of operative procedures described in the literature. Our own technique is presented, based on vaginal replacement by free, deserosized jejunal segments according to Wilfingseder. In addition, the muscularis propria layer was removed to improve trophic supply of the transplant which occurs initially only by diffusion. The free transplanted jejunal mucosa segments prevented transmural contamination of the mediastinum within the esophageal defect. Former animal experiments on beagles, as well as clinical experience with two newborn babies with long-gap esophageal atresia, showed that splinting for 4-6 weeks--beyond the time of the most intense wound contraction--and subsequent dilatation treatment could prevent circular and longitudinal shrinking of the transplants, thus avoiding stenosis. Histological findings revealed that on the average free-transplanted jejunal mucosa/submucosa tubes 8 cm long in dogs and 5 cm long in babies formed tubes of granulation tissue with the surrounding mediastinum, lined by persistent jejunal epithelium and partly by ingrowing esophageal epithelium. The two babies died 1/4 and 1 year following the operation, from their severe associated malformations. This, however, enabled us to do a thorough morphological examination of the interposed transplants and to document the complete healing. The advantages of the method described are primarily definitive bridging of the defect, less problems and risks as compared with elongation methods, and possibly shorter hospitalization.
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D000818:Animals; D004285:Dogs; D004933:Esophageal Atresia / Q000473:pathology / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007413:Intestinal Mucosa / Q000637:transplantation*; D007583:Jejunum / Q000637:transplantation*