Long-gap oesophageal atresia: comparison of delayed primary anastomosis and oesophageal replacement with gastric tube

2014 ◽  
Vol 49 (12) ◽  
pp. 1762-1766 ◽  
Author(s):  
Hui Qing Lee ◽  
Alisa Hawley ◽  
Joe Doak ◽  
Michael G. Nightingale ◽  
John M. Hutson
Keyword(s):  
Gastric Tube ◽  
Oesophageal Atresia ◽  
Primary Anastomosis ◽  
Long Gap ◽  
Oesophageal Replacement

scholarly journals Oesophageal Replacement in Children

2008 ◽  
Vol 90 (1) ◽  
pp. 7-12 ◽  
Author(s):  
GS Arul ◽  
D Parikh
Keyword(s):  
Gastric Tube ◽  
Oesophageal Atresia ◽  
Oral Feeding ◽  
Barrett’S Oesophagus ◽  
Oesophageal Reflux ◽  
Barrett's Oesophagus ◽  
Oesophageal Replacement ◽  
Significant Difference ◽  
Gastric Transposition

INTRODUCTION The usual indications for oesophageal replacement in childhood are intractable corrosive strictures and long-gap oesophageal atresia. Generally, paediatric surgeons attempt to preserve the native oesophagus with repeat dilatations. However, when this is not successful, an appropriate conduit must be fashioned to replace the oesophagus. The neo-oesophagus should allow normal oral feeding, not have gastro-oesophageal reflux, and be able to function well for the life-time of the patient. PATIENTS AND METHODS A Medline search for oesophageal replacement, oesophageal atresia, gastric transposition, colon transposition, gastric tube, caustic stricture was conducted. The commonest conduits including whole stomach, gastric tube, colon and jejunum are all discussed. RESULTS No randomised controlled studies exist comparing the different types of conduits available for children. The techniques used tend to be based on personal preference and local experience rather than on any discernible objective data. The biggest series with long-term outcome are reported for gastric transposition and colon replacement. Comparison of a number of studies shows no significant difference in early or late complications. Early operative complications include graft necrosis, anastomotic leaks and sepsis. Late problems include strictures, poor feeding, gastro-oesophageal reflux, tortuosity of the graft and the development of Barrett's oesophagus. The biggest series, however, seem to have lower complications than small series probably reflecting the experience, built up over years, in their respective centres. CONCLUSIONS Long-term follow-up is recommended because of the risks of late strictures, excessive tortuosity of the neo-oesophagus and the development of Barrett's oesophagus.

scholarly journals Late life revision surgery for dilated colonic conduit in long gap oesophageal atresia

2018 ◽  
Vol 100 (7) ◽  
pp. e185-e187 ◽  
Author(s):  
A Baggaley ◽  
T Reid ◽  
J Davidson ◽  
P de Coppi ◽  
A Botha
Keyword(s):  
Revision Surgery ◽  
Oesophageal Atresia ◽  
Late Life ◽  
Adult Patients ◽  
Colonic Interposition ◽  
Long Gap ◽  
Oesophageal Replacement ◽  
Colonic Conduit

Long gap oesophageal atresia presents a surgical challenge as there is insufficient length of the oesophagus to restore continuity. Oesophageal replacement is generally achieved using a conduit, taken from the stomach, jejunum or colon. Preferences of approach vary between and within surgical centres. Specific to colonic interposition, the continued growth and dilation of the interposed segment may lead to redundancy. Revision surgery in these cases is challenging and has been sparsely described in adult patients. We present two patients who had colonic interposition for long gap oesophageal atresia in infancy and who then underwent successful revision surgery in their fifth decade.

Long-term results of delayed primary anastomosis for pure oesophageal atresia: a 27-year follow up

2007 ◽  
Vol 23 (7) ◽  
pp. 647-651 ◽  
Author(s):  
Thambipillai Sri Paran ◽  
Diane Decaluwe ◽  
Martin Corbally ◽  
Prem Puri
Keyword(s):  
Oesophageal Atresia ◽  
Primary Anastomosis ◽  
Long Term Results

scholarly journals An interesting case of ‘strange lines’ a neonate with oesophageal atresia, tracheo-oesophageal fistula, situs inversus abdominalis and azygos continuation

2019 ◽  
Vol 12 (11) ◽  
pp. e229929
Author(s):  
Camille Legat ◽  
Maissa Rayyan ◽  
Herbert Decaluwe ◽  
Katherine Carkeek
Keyword(s):  
Situs Inversus ◽  
Oesophageal Atresia ◽  
Primary Anastomosis ◽  
Azygos Vein ◽  
Interesting Case ◽  
Line Position ◽  
Short Segment ◽  
X Ray ◽  
Azygos Continuation ◽  
Term Baby

We describe the case of a term baby boy born via vaginal delivery at 39 weeks gestation with oesophageal atresia, tracheaoesophageal fistula, situs inversus abdominalis and azygos continuation. The azygos continuation was diagnosed after cardiac echo and confirmed on cardiac catherisation after an unexpected umbilical line position on thoracoabdominal X-ray. The baby underwent a right-sided thoracotomy on day 1 of life for repair of the oesophageal atresia. A double fistula, of both the proximal and distal segments, of the oesophagus with short segment stenosis was confirmed. The tracheo-oesophageal fistulae were ligated and divided and the oesophageal atresia repaired by primary anastomosis without complications. The azygos vein was not ligated.

DOZ047.97: Anastomotic strictures in patients with oesophageal atresia systematically treated with PPI: prospective cohort study over 10 years

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
F R Grunder ◽  
L M Petit ◽  
J Ezri ◽  
P Jantchou ◽  
A Aspirot ◽  
...  
Keyword(s):  
Cohort Study ◽  
Gastroesophageal Reflux ◽  
Surgical Repair ◽  
Oesophageal Atresia ◽  
Univariate Analysis ◽  
Trigger Factor ◽  
Categorical Variables ◽  
Long Gap ◽  
Anastomotic Strictures ◽  
Prospective Longitudinal

Abstract Objectives and Study Clinical course in oesophageal atresia (OA) patients is frequently complicated by gastroesophageal reflux disease, which is thought to be a risk factor for formation of anastomotic strictures. It is currently recommended that OA patients be treated systematically with proton pump inhibitors (PPI) after surgical repair. However, it is not clear if PPI treatment does really prevent the formation of anastomotic strictures and reduce the incidence of histological complications during long-term follow up. This study aimed to describe the outcomes of a cohort of OA patients with or without tracheoesophageal fistula (TOF) systematically treated with PPI since the neonatal period. Method Prospective longitudinal cohort study over 11 years of 73 children with OA-TOF, systematically treated with PPI, was carried out. Descriptive data is presented as median (interquartiles) for continuous variables and as frequency (%) for categorical variables. Pearson's χ2 test, Fisher's exact test, and Wilcoxon rank sum test were used for univariate analysis. SAS software, version 9.3 (SAS Institute, Cary, NC) was used; P-values < 0.05 were considered statistically significant. Results Seventy-three patients (41 males) were included in the final analysis. The median age at study completion was 4.87 years (3.64, 7.97; range 1–11.4). According to Gross classification, 64 patients (88%) had OA type C, 8 (11%) had type A, and 1 (1%) had type D; long-gap OA was present in 16 patients (22%). Thoracotomy was performed in 56 patients and thoracoscopy in 17. Anastomotic strictures and recurrent strictures were diagnosed in 32 (44%) and 17 patients (23%), respectively. In all but one case, strictures occurred when the child was on PPI. Anastomotic strictures occurred significantly more frequently in long-gap OA, in patients with anastomotic leak after surgical repair and longer hospital stay (P = 0.02, 0.002, and 0.02 respectively). Histological complications, especially gastric metaplasia, appeared more frequently in OA patients with anastomotic strictures (P = 0.01). Conclusion Forty-two percent of patients developed anastomotic strictures on PPI treatment, therefrom 55% patients with recurrent anastomotic strictures, indicating that acid gastroesophageal reflux seems not to be the major trigger factor for developing anastomotic strictures. A more selective prescription of PPI should be discussed.

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