Jejunal Interposition

What is jejunal interposition?

Jejunal interposition is a procedure in which surgeons replace the missing section of a child's esophagus with a section of the jejunum (the middle part of the small intestine). It is used to treat children who have already undergone failed repair of long-gap esophageal atresia and for whom the Foker process isn't an option.

In this rare birth defect, a baby is born without part of the esophagus (the tube that connects the mouth to the stomach). Instead of forming a tube between the mouth and the stomach, the esophagus grows in two separate segments that do not connect. In long-gap esophageal atresia, so much of the esophagus is missing that the ends can't be easily connected with surgery.

When is jejunal interposition recommended?

Jejunal interposition is one of three surgical procedures that use portions of other organs to treat esophageal atresia in some children. In colon transposition, a piece of colon is moved and used as a replacement esophagus, while in gastric pull-up, the stomach is pulled up into the chest and connected directly to the top section of esophagus.

Although the jejunum is more difficult to work with than the colon or stomach, it provides several advantages to these other procedures. Your child has lots of jejunum available, so removing some does no significant harm. The jejunum is resistant to acid, which means your child is less likely to develop a reflux disorder as a result of the procedure. The diameter and wall width of the jejunum are a closer match to the esophagus than the colon is, making it a better overall fit. The jejunum also maintains its peristalsis, which means that it will continue to push food successfully once it's relocated to the esophagus. Jejunal interposition generally has better outcomes and results in shorter stays and fewer complications than alternatives, such as colonic interpositions or gastric pull-ups.

Jejunal interposition at Boston Children's Hospital

The Esophageal and Airway Treatment Center at Boston Children's Hospital is one of the only programs in the country specifically designed to care for children with all forms of esophageal atresia. We frequently receive and successfully repair patients who have failed treatment at other children's hospitals.

Jejunal Interposition Procedure

Jejunal Interposition 1
Planned incision
Jejunal Interposition 2
Removal of dysfunctional/damaged esophagus or prior esophageal replacement
Jejunal Interposition 3
Division of small bowel and transfer into lower neck
Jejunal Interposition 4a
Augmentation of blood flow to the interposition ("supercharging")
Jejunal Interposition 4b
Establishment of the connection between jejunal interposition conduit and remaining esophagus
Jejunal Interposition 5
Reconnecting small bowel in the abdomen to restore intestinal continuity
Jejunal Interposition 6
Reconnecting small bowel in the abdomen to restore intestinal continuity
Jejunal Interposition 7
Closure and possible drains (note: sometimes not all drains are needed)