Oesophageal Replacement: Jejunal Interposition
The jejunum has been utilized as an oesophageal replacement since the early 1900s. Decades of refinements and adjustments to the surgical techniques, in addition to improvements in both preoperative assessment and postoperative care, have resulted in the jejunum now being a reliable choice as an oesophageal substitute in both children and adults. It is widely utilized as either a free or pedicled graft or a combination of these as in the supercharged pedicled jejunal interposition. The most common indication for oesophageal replacement in infants is the management of long-gap oesophageal atresia and less frequently severe caustic strictures or resistant reflux strictures in older children. The benefits of the jejunum are it has a similar calibre to oesophagus, maintains intrinsic peristalsis, is much less likely than colon to develop redundant loops over time, is relatively abundant and is typically disease-free. Further benefits of the orthotopic pedicled jejunal interposition are retention of the native distal oesophageal pouch, including the oesophagogastric junction, thereby eliminating the long-term risks of reflux oesophagitis, an important consideration in the Pediatric population.
KeywordsOesophageal atresia Long-gap Jejunal interposition Oesophageal replacement Oesophageal substitution Ileal interposition