title: Jejunal Interposition after Failed Esophageal Atresia Repair.
abstract: The early outcomes of using jejunal interpositions to establish esophageal continuity in patients who have had a failed repair of esophageal atresia (EA) were determined.
  
  
  
  This was a retrospective review of all patients treated at our institution with a jejunal interposition after a failed EA repair from 2010 to 2015. Demographics, anatomy encountered, operative techniques, requirement for microvascular support, and length of stay were analyzed. Outcomes measures included conduit survival, as well as feeding status at last follow-up.
  
  
  
  Ten patients were reviewed. Median age at time of interposition operation was 48 months (range 8 to 276 months) and median weight was 14.2 kg (range 7.2 to 49.7 kg). Preoperative anatomy, operative techniques, and outcomes are presented. Four patients had microvascular "supercharging" for a long jejunal graft. Median follow-up was 1.5 years (range 0.5 to 5 years) with no long-term loss of graft or deaths. Six patients are eating by mouth completely, 1 by mouth primarily with supplemental night-time feeds, 1 is transitioning from tube to oral feeds, and 2 with functional grafts are fed mostly enterally due to severe oral aversion in 1 and aspiration in 1.
  
  
  
  Jejunal interpositions have been used for the past 5 years to establish esophageal continuity after a failed EA repair. All jejunal conduits survived and were joined to the upper esophageal segment. For shorter gaps with a longer upper esophageal pouch, a thoracic esophageal anastomosis was possible without additional vascular support. For longer interpositions into the neck, upper conduit survival might benefit from additional vascular anastomoses (ie, supercharging). To provide adequate space in the mediastinum, the first rib can be removed, as well as a portion of the manubrium to enlarge the pathway into the neck.
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Bairdain
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Boston, MA; Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN.
authors.forename: John E
authors.initials: JE
authors.lastname: Foker
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Charles Jason
authors.initials: CJ
authors.lastname: Smithers
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Hamilton
authors.affiliation: Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Brian I
authors.initials: BI
authors.lastname: Labow
authors.affiliation: Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Baird
authors.affiliation: Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Amir H
authors.initials: AH
authors.lastname: Taghinia
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Neil
authors.initials: N
authors.lastname: Feins
authors.affiliation: Division of Gastroenterology, Boston Children's Hospital, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Manfredi
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Boston, MA. Electronic address: russell.jennings@childrens.harvard.edu.
authors.forename: Russell W
authors.initials: RW
authors.lastname: Jennings
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004933:Esophageal Atresia / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007583:Jejunum / Q000637:transplantation*; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult