Super Charged Jejunal Tube (Microvascular Anastomosis)

Long-gap esophageal atresia (LGEA) in children poses significant functional and psychosocial challenges. A number of techniques to address LGEA include primary repair, esophageal traction-induced growth (e.g., Foker procedure) or esophageal replacements with stomach (gastric pull-up), small bowel or colonic interpositions; however, each of these approaches has limitations and may not be indicated for all LGEA patients. Of the esophageal replacements, the supercharged pedicled jejunal interposition (SPJI) is a technique which offers a number of advantages over the stomach or colon as conduits when the native esophagus cannot be used. SPJI interposes a segment of jejunum, keeping the distal jejunum connected to its native blood supply, while “supercharging” the transposed segment using neck or intrathoracic vessels to augment perfusion following transposition. SPJI is a technically complex and intensive intervention necessitating a multidisciplinary team approach. Recent studies support SPJI as a viable and safe option for children with LGEA who have failed previous reconstructive techniques. In addition, SPJI may provide a better long-term solution to LGEA in children where esophageal conduits must remain intact and functional for decades.