Oesophageal substitution with free and pedicled jejunum: short- and long-term outcomes

Abstract

In children, the indications for oesophageal substitution are principally, long gap oesophageal atresia (OA), severe anastomotic disruption following primary repair of OA and severe caustic or peptic strictures. We present an outcome review of eight cases who underwent oesophageal substitution with jejunum at our institution between 1986 and 2001. The purpose of this study was to evaluate our experience with free/pedicled jejunal grafts and its long-term outcome as an oesophageal substitute. Operative and postoperative outcome with free and pedicled jejunal grafts in four cases of pure OA, two cases of OA and distal tracheo-oesophageal fistula (TOF), one patient with a high retrolaryngeal oesophageal web and one case of severe caustic oesophageal stricture. Six patients had an oesophagostomy and a gastrostomy fashioned previously. Eleven free jejunal grafts were performed in six patients (three intraoperative redo interpositions for immediate graft loss, three separate grafts in one patient and two free grafts in two patients). One patient's pedicled jejunal graft proximally required microvascular anastomosis while the other had a pedicled graft without microvascular anastomosis. Early postoperative complications included four upper anastomotic leaks (three free grafts, one pedicled with microvascular support), pneumothorax requiring prolonged ventilation and Horner's syndrome. Recurrent laryngeal nerve injury occurred in the patient who had a high retrolaryngeal oesophageal web. During follow up (5-18 years) late complications of upper anastomotic stricture in four patients and graft redundancy with subsequent kinking of the lower anastomosis were observed in one patient. Three patients established a complete oral diet; a further three patients relied on supplemental gastrostomy feeds and one patient is entirely gastrostomy fed. There were two late deaths, one from aspiration and the other from a severe asthmatic attack (5 and 7 months postoperatively, respectively). Our results indicate that there are significant complications related to the use of free jejunal grafts. Early recognition and treatment are of paramount importance in the ultimate achievement of a successful technical outcome.

Esophagus Tissue Engineering: Hybrid Approach with Esophageal Epithelium and Unidirectional Smooth Muscle Tissue Component Generation In Vitro

“…[2][3][4] However, these strategies are frequently associated with a high rate of short-and long-term complications that include leakage, stricture, elongation, and gastro-esophageal reflux. [5][6][7] Tissue engineering of the esophagus could overcome these limitations and offer viable alternatives to these approaches.…”

Esophagus tissue engineering: in situ generation of rudimentary tubular vascularized esophageal conduit using the ovine model

“…are associated with a high incidence of short-and long-term complications that include leakage, stricture, elongation, and malnutrition because of shortening of the gastrointestinal tract [5][6][7]. There is an urgent need for viable alternatives, and tissue engineering technology could provide solutions to this problem.…”

In vitro Effect of Bethanechol and Suberyldicholine on Regions of Guinea Pig Esophagus

“…Bridging of esophageal defects by primary anastomosis is successful; however, in cases of long-gap esophageal atresia, current strategies are often associated with high rates of complications, including leakage, stricture, and gastro-esophageal reflux [2][3][4]. Recently, tissue engineering has been proposed as an alternative approach to esophageal repair [5].…”