Infant study of hemispheric asymmetry after long‐gap esophageal atresia repair

Abstract Since the very beginning in 1999, thoracoscopic repair of esophageal atresia has become a gold standard in many pediatric surgery centers worldwide. Despite the advances in surgical technique, treatment of long-gap esophageal atresia still remains a challenge. The aim of this study is to assess whether the localization of esophageal stumps can predict number of stages needed to perform anastomosis. We analyzed video records of 21 patients who underwent staged thoracoscopic repair of long-gap esophageal atresia using internal traction technique. All procedures were performed by the same surgeon. We divided patients into two groups: first requiring single internal traction procedure, second who underwent multiple procedures. We assessed esophageal stump position in relation to thoracic vertebrae. The distance between stumps was measured in vertebral bodies. Mean distance between esophageal ends was 5.8 in single traction group. The distance between the stumps was significantly greater in multiple procedures group: 7.33 (P = 0.003). Patients who required multiple procedures had significantly lower localization of distal stump. Localization of proximal stump did not affect the possibility for anastomosis after single traction. Distance between both ends after internal traction was also significantly longer in multiple procedures group. Patients with lower localization of distal esophageal stump assessed during primary thoracoscopy are at higher risk for requiring multiple surgical procedures.

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Hydrostatic stretch-induced growth facilitating primary anastomosis in long-gap esophageal atresia

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2006.01.076 ◽

2006 ◽

Vol 41 (6) ◽

pp. 1170-1172 ◽

Cited By ~ 18

Author(s):

Adam M. Vogel ◽

Edmund Y. Yang ◽

Steven J. Fishman

Keyword(s):

Esophageal Atresia ◽

Primary Anastomosis ◽

Long Gap ◽

Long Gap Esophageal Atresia

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Current Surgical Strategies in Long-gap Esophageal Atresia with Regard to Endoscopic Anastomosis

Long-gap Esophageal Atresia - Progress in Pediatric Surgery ◽

10.1007/978-3-642-70777-3_1 ◽

1986 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

D. Booss ◽

J. Kotlarski

Keyword(s):

Esophageal Atresia ◽

Surgical Strategies ◽

Long Gap ◽

Long Gap Esophageal Atresia

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DOZ047.36: Thoracoscopic esophageal internal axial traction for long- gap esophageal atresia

Diseases of the Esophagus ◽

10.1093/dote/doz047.36 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

M Juricic ◽

N Panait ◽

G Podevin ◽

A Bonnard ◽

P Lopez ◽

...

Keyword(s):

Esophageal Atresia ◽

Operative Time ◽

Median Number ◽

Ethical Review ◽

Multicenter Observational Study ◽

Long Gap ◽

Esophageal Anastomosis ◽

Long Gap Esophageal Atresia ◽

Axial Traction ◽

Median Operative Time

Abstract Aim of the Study Long-gap esophageal atresia (LGEA) remains a surgical challenge. This study aimed to report the results of thoracoscopic esophageal axial internal traction in LGEA. Methods This multicenter observational study included retrospectively neonates who underwent primary thoracoscopic esophageal axial internal traction for LGEA between June 2017 and July 2018. LGEA was defined as the technical impossibility to perform a primary esophageal anastomosis. The Ethical Review Board of our institution approved the study. Main Results Eight neonates were included with a median gestational age at birth of 35 weeks [25; 37] and a median birth weight of 2266 g [890; 3800], 6 types I and 2 types II according to Ladd's classification. Initial median gap between 2 esophageal ends was 5 vertebral bodies [4.5; 7]. Internal traction was performed at a median age of 5 weeks of life [1; 17] with a median operative time of 87 minutes. Four patients required at least 2 internal traction procedures. After a mean traction time of 1.5 weeks [1; 13.5], esophageal anastomosis was successfully performed in 7 patients (5 thoracoscopies, 2 thoracotomies) with a median operative time of 165 minutes. One patient needed a colonic interposition. Five of these 7 patients required an esophageal endoscopic dilatation (median number: 4 [2; 6]). Median follow-up was 9.75 months [3; 16]. Conclusions Thoracoscopic esophageal axial internal traction for LGEA was a safe and feasible procedure that allowed an esophageal anastomosis in 7 of the 8 patients. Improvement of the procedure requires setting a common protocol concerning the timing of the first internal axial traction and the duration of traction before considering esophageal anastomosis.

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Short-interval staged thoracoscopic surgery for long-gap esophageal atresia

Journal of Pediatric Endoscopic Surgery ◽

10.1007/s42804-019-00002-3 ◽

2019 ◽

Vol 1 (1) ◽

pp. 37-40

Author(s):

Juan C. de Agustín-Asensio ◽

Beatriz Fernández-Bautista ◽

María Antonia García-Casillas

Keyword(s):

Esophageal Atresia ◽

Thoracoscopic Surgery ◽

Short Interval ◽

Long Gap ◽

Long Gap Esophageal Atresia

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Neurologic Injury and Brain Growth in the Setting of Long-Gap Esophageal Atresia Perioperative Critical Care: A Pilot Study

Brain Sciences ◽

10.3390/brainsci9120383 ◽

2019 ◽

Vol 9 (12) ◽

pp. 383 ◽

Cited By ~ 5

Author(s):

Samuel S. Rudisill ◽

Jue T. Wang ◽

Camilo Jaimes ◽

Chandler R. L. Mongerson ◽

Anne R. Hansen ◽

...

Keyword(s):

Pilot Study ◽

Esophageal Atresia ◽

Brain Volume ◽

Brain Mri ◽

Full Term ◽

Brain Growth ◽

Term Infants ◽

Long Gap ◽

Long Gap Esophageal Atresia ◽

The Impact

We previously showed that infants born with long-gap esophageal atresia (LGEA) demonstrate clinically significant brain MRI findings following repair with the Foker process. The current pilot study sought to identify any pre-existing (PRE-Foker process) signs of brain injury and to characterize brain and corpus callosum (CC) growth. Preterm and full-term infants (n = 3/group) underwent non-sedated brain MRI twice: before (PRE-Foker scan) and after (POST-Foker scan) completion of perioperative care. A neuroradiologist reported on qualitative brain findings. The research team quantified intracranial space, brain, cerebrospinal fluid (CSF), and CC volumes. We report novel qualitative brain findings in preterm and full-term infants born with LGEA before undergoing Foker process. Patients had a unique hospital course, as assessed by secondary clinical end-point measures. Despite increased total body weight and absolute intracranial and brain volumes (cm3) between scans, normalized brain volume was decreased in 5/6 patients, implying delayed brain growth. This was accompanied by both an absolute and relative CSF volume increase. In addition to qualitative findings of CC abnormalities in 3/6 infants, normative CC size (% brain volume) was consistently smaller in all infants, suggesting delayed or abnormal CC maturation. A future larger study group is warranted to determine the impact on the neurodevelopmental outcomes of infants born with LGEA.

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