Slide Esophagoplasty vs End-to-End Anastomosis for Recalcitrant Esophageal Stricture after Esophageal Atresia Repair

Abstract Aim To assess the risk factors for anastomotic stricture (AS) in end-to-end anastomosis (EEA) in patients with esophageal atresia (EA). Methods With ethical consent, hospital records of 341 EA patients from 1980 to 2020 were reviewed. Patients with less than 3 months survival (n = 30) with Gross type E EA (n = 24) and with primary reconstruction (n = 21) were excluded. Outcome measures were revisional surgery for anastomotic stricture (RSAS) and number of dilatations required for anastomotic patency without RSAS. The factors that were tested for risk of RSAS or dilatations were distal tracheoesophageal fistula (TEF) at the carina in C-type EA (congenital TEF [CTEF]), type A/B EA, antireflux surgery (ARS), anastomotic leakage, recurrent TEF, and Spitz group and congenital heart disease. Main Results A total of 266 patients, Gross type A (n = 17), B (n = 3), C (n = 237), or D (n = 9) underwent EEA (early n = 240, delayed n = 26). Early anastomotic breakdown required secondary reconstruction in five patients. Of the remaining 261 patients, 17 (6.1%) had RSAS, whereas 244 patients with intact end to end required a median of five (interquartile range: 2–8) dilatations for anastomotic patency. Main risk factors for RSAS or (> 8) dilatations were CTEF, type A/B, ARS, and anastomotic leakage that increased the risk of RSAS or dilatations from 4.6- to 11-fold. Conclusion The risk of severe AS is associated with long-gap EA, significant gastroesophageal reflux, and anastomotic leakage.

Download Full-text

Esophageal atresia with tracheoesophageal fistula: End-to-end versus end-to-side repair

Journal of Pediatric Surgery ◽

10.1016/s0022-3468(78)80113-4 ◽

1978 ◽

Vol 13 (6) ◽

pp. 677-681 ◽

Cited By ~ 16

Author(s):

John B. Pietsch ◽

Keith B. Stokes ◽

Harvey E. Beardmore

Keyword(s):

Esophageal Atresia ◽

Tracheoesophageal Fistula ◽

End To End

Download Full-text

Endoscopic Assessment of Children with Esophageal Atresia: Lack of Relationship of Esophagitis and Esophageal Metaplasia to Symptomatology

Canadian Journal of Gastroenterology ◽

10.1155/2010/902847 ◽

2010 ◽

Vol 24 (5) ◽

pp. 312-316 ◽

Cited By ~ 24

Author(s):

Julie Castilloux ◽

Dorothée Bouron-Dal Soglio ◽

Christophe Faure

Keyword(s):

Intestinal Metaplasia ◽

Esophageal Atresia ◽

Esophageal Stricture ◽

Cross Sectional Study ◽

Late Complications ◽

Cross Sectional ◽

Gastric Metaplasia ◽

Present Cross Sectional Study ◽

Endoscopic Assessment ◽

Relationship Of

BACKGROUND: Late complications of esophageal atresia (EA), particularly esophagitis and Barrett’s esophagus, are increasingly being recognized. With the exception of patients with dysphagia associated with esophageal stricture, it is unknown whether patient symptomatology can predict endoscopic findings.METHODS: Data regarding the digestive symptoms of patients who were referred to the EA multidisciplinary clinic from October 2005 to October 2008, and underwent upper gastrointestinal endoscopic evaluation, were systematically collected. Macroscopic and histological findings were analyzed. Endoscopy was considered normal if no esophagitis, intestinal metaplasia or gastric metaplasia (GM) was discerned.RESULTS: Sixty-three patients underwent endoscopy. Eighteen had dysphagia related to an esophageal stricture needing dilation and were subsequently excluded from the analysis. Forty-five patients (26 girls) with a median age of 7.3 years (range 0.4 to 17.9 years) were evaluated. Twenty-six patients (58%) were normal at endoscopy, 14 patients (31%) had esophagitis and 16 patients (36%) had GM. No intestinal metaplasia or adenocarcinoma was detected. Six patients with abnormal endoscopy results were asymptomatic. No correlation between digestive symptoms and endoscopy results was found.CONCLUSION: The present cross-sectional study showed that symptomatology was not predictive of abnormal endoscopy in EA patients. Esophagitis or GM may be discovered, even in the absence of symptoms, suggesting that physicians cannot rely solely on symptomatology to accurately evaluate the extent of these esophageal complications in this population.

Download Full-text

Outcomes of esophagoplasty in children (a 14-year experience)

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2020-24-6-358-362 ◽

2021 ◽

Vol 24 (6) ◽

pp. 358-362

Author(s):

N. N. Akhparov ◽

S. B. Suleimanova ◽

V. E. Litosh

Keyword(s):

Esophageal Atresia ◽

Pediatric Surgery ◽

Esophageal Stricture ◽

Varicose Veins ◽

Surgical Interventions ◽

Surgical Department ◽

Peptic Stricture ◽

One Stage ◽

Abdominal Organs ◽

Points Of View

Introduction. The authors analyze the effectiveness of one-stage esophageal plasty in children. They consider -from different points of view- possible problems accompanying such surgical interventions as well as complications and high mortality.Material and methods. The article summarizes outcomes after esophagoplasty in 61 patient who were at the surgical department of the Center for Pediatrics and Pediatric Surgery (Almaty, Kazakhstan) during 2006–2020 (June). Among them there were 24 (38%) children after the first stage of cervical esophagostomy combined with gastrostomy in esophageal atresia; 34 (56%) children had decompensated post-burn esophageal stricture and after ineffective conservative treatment; 1 (2%) patient had esophageal varicose veins because of the portal hypertension syndrome with formed cicatricial esophageal stricture and with high risk for bougienage; 2 (4%) patients had an extended peptic stricture of the esophagus as a complication of gastroesophageal reflux disease (Barrett esophagus).Results. One-stage coloesophagoplasty was performed in 44 (72%) children. Gastroesophagoplasty with the whole stomach transposition was performed in 12 (20%) children with esophageal atresia; in 3 (5%) - replacement for post-burn cicatricial stenosis and in 1 (2%) - because of varicose veins in the esophagus.Conclusion. The choice of esophagoplasty technique should be individualized depending on patient’s general state, on pathological lesions in the esophagus as well as on previous surgeries on the abdominal organs, if any.

Download Full-text

Esophageal Stricture following Esophageal Atresia Repair: Endoscopic Assessment and Dilation

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949310200502 ◽

1993 ◽

Vol 102 (5) ◽

pp. 332-336 ◽

Cited By ~ 8

Author(s):

Bruce Benjamin ◽

Peter Robb ◽

Martin Glasson

Keyword(s):

Esophageal Atresia ◽

Esophageal Stricture ◽

Primary Repair ◽

Stricture Formation ◽

Endoscopic Dilation ◽

Pediatric Use ◽

Endoscopic Assessment ◽

Surprising Finding ◽

Sydney Australia

A retrospective review from 1981 to 1986 was made of 51 neonates who were treated for congenital esophageal atresia at the Royal Alexandra Hospital for Children, Sydney, Australia. Thirty of the 51 had primary repair and 15 (50%) developed esophageal stricture requiring one or more dilations. Stricture dilations were performed with open-tube rigid esophagoscopes, rigid telescopes, and Jackson dilators. The number of dilations performed until the patient was asymptomatic ranged from 1 to 12 (mean 4.5). The minimal follow-up time was 4 years. There was one esophageal perforation with full recovery following conservative management. One child died of septicemia caused by continued aspiration of unknown cause. A surprising finding, contrary to other reports, was that stricture formation did not appear to be related to the size of the “gap” found at the time of esophageal repair. Gastroesophageal reflux, however, was an important factor. We conclude that esophageal stricture following repair of tracheoesophageal atresia can be satisfactorily and relatively safely managed by direct vision antegrade endoscopic dilation using graduated dilators, although treatment may be prolonged and repeated. New esophagoscopes and dilators, in graduated sizes and designed for pediatric use, are recommended. The technique of esophageal dilation in infants is described in detail. Pediatric laryngobronchoesophagologists will become more involved in the care of infants born with esophageal atresia with or without tracheoesophageal fistula.

Download Full-text

A comparison of the results of primary repair of esophageal atresia with tracheoesophageal fistulas using end-to-side and end-to-end anastomoses

Journal of Pediatric Surgery ◽

10.1016/0022-3468(73)90402-8 ◽

1973 ◽

Vol 8 (5) ◽

pp. 641-645 ◽

Cited By ~ 18

Author(s):

Sigmund H. Ein ◽

Terrill E. Theman

Keyword(s):

Esophageal Atresia ◽

Primary Repair ◽

End To End ◽

Comparison Of The Results

Download Full-text

What is the Best Choice for Esophageal Replacement in Children?

American Journal of Surgical Case Reports ◽

10.31487/j.ajscr.2020.02.10 ◽

2020 ◽

pp. 1-5

Author(s):

Ashjaei Bahar ◽

Movahedi Jadid Merisa ◽

Parvizi Azita ◽

Talebi Ali

Keyword(s):

Gastroesophageal Reflux ◽

Esophageal Atresia ◽

Esophageal Stricture ◽

Oral Feeding ◽

Esophageal Replacement ◽

Technical Problems ◽

Advantages And Disadvantages ◽

Long Gap ◽

Surgical Methods ◽

Long Gap Esophageal Atresia

Esophageal replacement surgery is performed in children with either congenital long gap esophageal atresia or acquired esophageal damages such as caustic injury of the esophagus. although the left colon because of less variation in blood supply and suitable diameter in comparison with right colon is the better choice. A secured pedicled colon is mandatory for reducing the sever complications, such as leak and necrosis. Ileocolic conduit is an alternative method of colon interposition which has anti reflux effect and therefore with less complications related to gastroesophageal reflux. When we have a short segment esophageal stricture due to corrosive esophagitis or other causes of esophageal strictures which is refractory to repeated dilatations, it is advisable to perform colon patch esophagoplasty. Gastric transposition can produce a good way for gastrointestinal continuity with a perfect weight gain and oral feeding, therefor it can be a safe choice for esophageal replacement in children. Partial gastric pull-up is an alternative operation for esophageal replacement in children and infants with long gap esophageal atresia. Gastric conduit replacement is another alternative technique for esophageal replacement, in which a gastric tube is created in the abdomen and it is pulled to via thoracic cavity to the neck and is committed by cervical anastomosis. Antral patch esophagoplasty is used for benign and limited esophageal stricture due to gastroesophageal reflux. Usefulness of pedicled jejunum was under optimal results because of technical problems and high rate of necrosis and mortality for decades. Sternocleidomastoid myocutaneous esophagoplasty is a scarce method which is reported by some surgeons for limited cervical esophageal stricture repair. Free microvascular transfer of the reverse ileo-colon flap with ileocaecal valve valvuloplasty is used for reconstruction of a pharyngoesophageal defect, and Patch esophagoplasty by using of degradable bioscaffolds of extracellular matrix have shown good results in preclinical and clinical outcomes to prevent stenosis after endoscopic mucosectomy. We will explain the advantages and disadvantages of these different surgical methods in this review article.

Download Full-text