If a child has esophageal atresia that has not become severe enough to require surgery, Jejunal Interposition may be a treatment option. The mechanics of this operation involve using the jejunum (the middle part of the small intestine) to replace the missing section of the esophagus.
What is it?
Esophageal atresia is a birth defect which prevents the upper and lower parts of the esophagus from connecting. The areas of the esophagus form separately, and this condition is lethal unless properly treated. There are many procedures that may be able to help including the Foker process and various graft surgeries. A jejunal interposition may be the third choice for surgery if surgeons cannot use tissue from the patient’s stomach or colon. While the jejunum closely resembles the esophagus in shape and can effectively transport food, it has a limited arterial supply. When successful, however, a jejunal interposition surgery can save a patient’s life.
What should I do to prepare?
Consult your surgeon before the surgery about any medications the patient may be taking. The patient may also be asked to change their diet in the days before the procedure, possibly involving an all-liquid diet. The patient cannot eat or drink anything after midnight of the night before surgery unless instructed otherwise. Inform the surgeon of any illnesses or disorders the patient may have recently developed before the surgery.
What happens during the process?
The patient will be under general anesthesia for this procedure and will be positioned lying on their back. Incisions will be made in the abdomen, chest, and neck. The portion of the jejunum to be removed is cut out and the two open ends of the GI tract are sutured together. The removed portion of the jejunum is then attached to the esophagus or stomach depending on where it is needed. The jejunum may also be stretched or distorted in a number of ways based on the patient’s individual anatomy. First, the blood vessels are connected, followed by the completion of the esophageal tract. Following the surgery, patients are moved directly to the ICU with jejunal feeding beginning on the third or fourth day following surgery.
What are the risks and potential complications?
Some associated risks and complications include, but are not limited to, excessive bleeding and infection, abnormal healing of the jejunum or esophagus, anastomotic leak, loss of vascular supply to the jejunum, complete loss of the graft, and difficulty swallowing.
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