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

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.

DOZ047.93: Thoracoscopic multistage repair of long-gap esophageal atresia using internal traction suture technique—evolution of the method

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
D Patkowski ◽  
S Gerus ◽  
M Rasiewicz
Keyword(s):  
Esophageal Atresia ◽  
Traction Force ◽  
Suture Technique ◽  
Thoracoscopic Approach ◽  
Long Gap ◽  
Thoracoscopic Repair ◽  
Esophageal Anastomosis ◽  
Traction Suture ◽  
Long Gap Esophageal Atresia ◽  
Two Stages

Abstract Treatment of long-gap esophageal atresia poses a great challenge for a surgeon. A new multistage thoracoscopic repair of long-gap esophageal atresia using internal traction technique was developed that evolved with time and growing experience. The goal of this study is to present the changes in the strategy and important technical aspects of the operative method based on a retrospective analysis of performed surgeries. Methods and Materials Thirty-five cases of newborns with long-gap esophageal atresia (type A-26 cases and B-9 cases exclusively) were operated thoracoscopically between 2008 and 2019 using internal traction technique in different pediatric surgery centers (Poland–28, Czech–1, Ukraine–1, Switzerland–2, Egypt–2, Russia–1). The idea of the internal traction technique was to place the suture between thoracoscopically mobilized esophageal pouches and keep a static tension between them for a period of time. Patients were operated on as early as it was possible after birth. Results Of the 35 newborns operated on using internal traction 2 patients died before the final stage from not surgically-related causes. Two patients had complications that required neck fistula and had later Collis–Nissen and colon interposition, respectively. One case is awaiting the final procedure. For 31 cases the final esophageal anastomosis was completed in two stages–16 cases, three stages–9, four stages–2, five stages–2, and six stages–1. At the beginning the time between stages was planned for 4 weeks (for some cases it was even longer) and it was shortened for the last three cases to 5 days. It allowed avoiding gastrostomy in two cases. The internal traction was modified from using two traction loops to one traction loop with two slipping knots on each branch of the loop. The clips were applied transversely through the tip of each pouch and part of the traction loop to prevent disruption and pouch perforation. It also allowed increasing of the created static traction force. Conclusion Results of the study may indicate that in a majority of long-gap esophageal atresia it is possible to preserve the native esophagus by a thoracoscopic approach using an internal traction suture technique. Shortened time between stages allowed completion of the final esophageal anastomosis with gastrostomy avoidance.

scholarly journals Esophageal elongation using Foley catheter in long-gap esophageal atresia

2020 ◽  
Vol 9 ◽  
pp. 26
Author(s):  
Maher Alzaiem
Keyword(s):  
Esophageal Atresia ◽  
Foley Catheter ◽  
Surgical Techniques ◽  
Effective Technique ◽  
Long Gap ◽  
Esophageal Anastomosis ◽  
Long Gap Esophageal Atresia ◽  
Type C ◽  
Continuous Feeding ◽  
Esophageal Pouch

Esophageal atresia/tracheoesophageal fistula (EA/TEF) is a rare congenital anomaly that poses major surgical challenges, particularly when the distance between the two esophageal ends exceeds 3 cm. Many surgical techniques are advocated for bridging the gap between the two esophageal ends. In this paper, we propose a simple and effective technique to elongate the esophagus in the long gap EA. This technique has successfully been applied in two infants with type C EA/TEF, where a primary end to end esophageal anastomosis was not feasible. The technique uses two Foley catheters for traction of upper and lower esophageal ends in long-gap EA/TEF. This method helps preserve the native esophagus, providing comfortable suction of the upper esophageal pouch, and assuring postoperative continuous feeding through the lower esophageal segment.

DOZ047.124: Thoracoscopic anatomy of long-gap esophageal atresia. What can we predict?

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
M Rasiewicz ◽  
K Świątek ◽  
S Gerus ◽  
D Patkowski
Keyword(s):  
Esophageal Atresia ◽  
Gold Standard ◽  
Distal Stump ◽  
Thoracic Vertebrae ◽  
Long Gap ◽  
Thoracoscopic Repair ◽  
Proximal Stump ◽  
Long Gap Esophageal Atresia ◽  
Vertebral Bodies ◽  
Traction Group

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.

DOZ047.53: Esophageal balloon dilatation for strictures developing after esophageal atresia surgery

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
C U Durakbasa ◽  
B Aksu ◽  
E Uzun ◽  
D Ugurlu ◽  
S Aydoner ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Balloon Dilatation ◽  
Colonic Anastomosis ◽  
Median Number ◽  
Esophageal Replacement ◽  
Replacement Surgery ◽  
Anastomosis Site ◽  
Esophageal Anastomosis ◽  
Esophageal Balloon ◽  
Target Pressure

Abstract Aim The aim of this study is to evaluate the results of esophageal balloon dilatation (BD) for strictures after esophageal atresia (EA) surgery. Methods Flexible endoscopic BD was done under fluoroscopic and manometric control. The balloon placed in the stricture was inflated by contrast. The target pressure and the diameter were decided in compliance with the manufacturer's directions as well as fluoroscopic guidance. The balloon was kept inflated for 3 minutes. Prospectively collected data over 10 years were retrospectively evaluated. Cure was defined as no need for dilatation during the last 12 months. Results A total of 79 patients with variable diagnoses underwent 481 BD. Forty (51%) had strictures which developed after EA surgery. They underwent 175 (36%) BD (P < 0.05). There were 21 males and 19 females. The atresia was distal fistula type in 31 (77.5%) patients and isolated EA in nine (22.5%). The BD was done for primary esophago-esophageal anastomosis site in 37 patients. The remaining three patients with long gap EA had undergone previous replacement surgery and the BD was done for the proximal esophago-colonic anastomosis. The median age at the time of the first BD was 14 months with 17 (43%) patients below the age of 1 year. The maximal inflation diameter varied between 5–20 mm. Esophageal BD catheters were used in all except two occasions where 5 mm ureteral balloons were used. The median number of BD was four (n = 1–15). Thirty-four (85%) patients underwent more than one BD. A transmural perforation was encountered in one occasion (0.6%) and the patient eventually underwent esophageal replacement surgery with an uneventful outcome. There was no mortality. Fundoplication was done in nine patients. Thirty-three patients (82.5%) were regarded as ‘cure’. Conclusion Esophageal BD is employed for strictures caused by a variety of reasons. Patients with EA comprise a substantial number of cases needing BD and have strictures less resistant to dilatation. The technique employed in this study is advantageous because it enables direct endoscopic visualization of the stricture and both gradual and controlled increase of the dilatation pressure. BD is safe and efficient yet there is a risk of esophageal perforation as in the other dilatation techniques.

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

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

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

2019 ◽  
Vol 9 (12) ◽  
pp. 383 ◽  
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.

Sign in / Sign up

Export Citation Format

Share Document