ABSTRACT
Reconstruction of the esophagus in long-gap esophageal atresia has always been a challenge. In 1946, Reinhoff performed an intrathoracic jejunal replacement of the esophagus. Jejunal interposition for long-gap esophageal atresia was first described by Akiyama in 1971, and was later adopted by Bax. The technique is demanding, but the results are encouraging, even in the long term. The first step in a neonate with a long-gap esophageal atresia is usually the placement of a gastrostomy for feeding. During this procedure, a tracheobronchoscopy is carried out to exclude a proximal fistula. Jejunal interposition is accomplished under general anesthesia. A contrast swallow is performed on postoperative day 5. If there is no leakage, oral feeding can be initiated. The major advantage of jejunal pedicle grafts is that they grow at the same speed as the native esophagus, redundancy does not occur, and the grafts display peristalsis, thus facilitating good passage of solid food.
