Firriolo, Joseph M.

Ganske, Ingrid M.

Hamilton, Thomas E.

Jennings, Russell W.

Labow, Brian I.

Smithers, C. Jason

Taghinia, Amir H.

Upton, Joseph

Harvard University - DASH 

Abstract: Esophageal Reconstructionwith Supercharged JejunalInterposition: A Reliable Interventionfor Establishing EsophagealContinuity in a Pediatric PopulationThe Harvard community has made thisarticle openly available.  Please share  howthis access benefits you. Your story mattersCitation Firriolo, Joseph M., Ingrid M. Ganske, Amir H. Taghinia, ThomasE. Hamilton, C. Jason Smithers, Joseph Upton, Russell W.Jennings, and Brian I. Labow. 2017. “Abstract: EsophagealReconstruction with Supercharged Jejunal Interposition: A ReliableIntervention for Establishing Esophageal Continuity in a PediatricPopulation.” Plastic and Reconstructive Surgery Global Open 5(9 Suppl): 165. doi:10.1097/01.GOX.0000526402.63110.f8. http://dx.doi.org/10.1097/01.GOX.0000526402.63110.f8.Published Version doi:10.1097/01.GOX.0000526402.63110.f8Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:34492411Terms of Use This article was downloaded from Harvard University’s DASHrepository, and is made available under the terms and conditionsapplicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA165PSTM 2017 Abstract SupplementMonday,  October 9, 2017levels. 30.6% of patients had high aFXa levels, including 12.2% of the population who were ther-apeutically anti-coagulated. Patient weight pre-dicted enoxaparin metabolism (r2value of 0.45). When compared to patients given enoxaparin 40mg once daily, patients given enoxaparin 40mg twice daily 1) were significantly less likely to have low aFXa (9.2% vs. 44.1%, p<0.001), 2) had non-significant increase in clinically relevant bleeding (6.1% vs. 3.2%%, p=0.34), and 3) had significantly fewer post-operative VTE (0% vs. 5.3% p=0.021).CONCLUSION: With enoxaparin 40mg twice daily, only 9.2% of patients receive inadequate prophylaxis based on aFXa level. This is relevant because prior work has correlated inadequate prophylaxis with symptomatic VTE after plastic surgery procedures. When compared to patients who receive enoxaparin 40mg per day, patients who receive enoxaparin 40mg twice daily had significantly fewer VTE and had non-significant increase in clinically relevant bleeding. Ongoing patient recruitment will further define the effec-tiveness and safety profile of this intervention.ACKNOWLEDGEMENTS: This work was funded by an R03 grant from the Agency for Healthcare and Research Quality. The Plastic Surgery Foun-dation NEPS grant mechanism funded the initial trial which provide comparasion data here.Esophageal Reconstruction with Supercharged Jejunal Interposition: A Reliable Intervention for Establishing Esophageal Continuity in a Pediatric PopulationPresenter: Joseph M. Firriolo, MDCo-Authors: Ingrid M. Ganske, MD, MPA; Amir H. Taghinia, MD, MPH; Thomas E. Hamilton, MD; C. Jason Smithers, MD; Joseph Upton, MD; Russell W. Jennings, MD; Brian I. Labow, MDAffiliation: Boston Children’s Hospital, Harvard Medical School, Boston, MAINTRODUCTION: In children, esophageal defects cause significant morbidity. The Foker procedure, gastric pull-up, and colonic interposition have demonstrated success in establishing esophageal continuity. However, these forms of esophageal repair are susceptible to failure. Additionally, cases exist where varied anatomy and previous surgery may preclude the application of these procedures. In such cases, jejunal interposition may be consid-ered. “Supercharging” pedicled jejunal flaps allows for longer conduits, and serves to improve flap per-fusion, healing, and function. Previous studies have questioned the feasibility of this intervention in a pediatric population. The purpose of this study is to describe the outcomes of pediatric patients who underwent supercharged jejunal interposition for esophageal reconstruction at our institution.METHODS: We reviewed the records of patients who underwent esophageal reconstruction using supercharged pedicled jejunal (SPJ) flaps at our institution from 2013–2017.RESULTS: Thirteen patients, aged 1.4–23.8 years, underwent esophageal reconstruction with SPJ flaps. Eleven patients had esophageal atresia and two developed esophageal strictures secondary to caustic ingestion. All had previously undergone failed attempts at restoring esophageal continu-ity. Patients have been followed-up for an average of 19.7 months. Reconstruction with SPJ flaps was laborious and technically demanding, taking an average of 11.8 ± 3.1 hours. Most cases (92.3%) involved the microsurgical anastomoses of an internal thoracic artery and vein to jejunal arte-rial and venous branches, respectively. All patients were discharged with an intact SPJ flap, and there were no morbidities. For two children, the postop-erative course was complicated by chest wall infec-tions; another individual experienced small bowel obstruction. So far, four patients have required endoscopic stricture dilation, and one child has returned to the operating room for relocation of their jejunogastric anastomosis. Following recon-struction, patients were intubated for an average of 8.7 ± 3.7 days, and monitored in the intensive care unit for a mean of 18.0 ± 7.3 days. By postop-erative day 50 (range, 15–50 days), all were able to meet their caloric needs enterally. Currently, eleven patients (84.6%) are tolerating oral feeds.CONCLUSION: Although the complexity of SPJ flaps limits their widespread use, our group’s experience with this technique demonstrates the feasibility of this intervention in the pediatric population. When performed by an experienced, multidisciplinary team, this approach is reliable and should be considered for children with lim-ited reconstructive options.

Abstract: Esophageal Reconstruction with Supercharged Jejunal Interposition: A Reliable Intervention for Establishing Esophageal Continuity in a Pediatric Population

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Abstract: Esophageal Reconstruction with Supercharged Jejunal Interposition: A Reliable Intervention for Establishing Esophageal Continuity in a Pediatric Population

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