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.

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.

DOZ047.36: 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.

scholarly journals Brain Oxygenation During Thoracoscopic Repair of Long Gap Esophageal Atresia

2017 ◽  
Vol 41 (5) ◽  
pp. 1384-1392 ◽  
Author(s):  
Lisanne J. Stolwijk ◽  
David C. van der Zee ◽  
Stefaan Tytgat ◽  
Desiree van der Werff ◽  
Manon J. N. L. Benders ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Brain Oxygenation ◽  
Long Gap ◽  
Thoracoscopic Repair ◽  
Long Gap Esophageal Atresia

Benefits of the Thoracoscopic Approach for Short- or Long-Gap Esophageal Atresia

2005 ◽  
Vol 15 (6) ◽  
pp. 673-677 ◽  
Author(s):  
Hossein Allal ◽  
Nicolas Kalfa ◽  
M. Lopez ◽  
D. Forgues ◽  
M.P. Guibal ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Thoracoscopic Approach ◽  
Long Gap ◽  
Long Gap Esophageal Atresia

Two-Stage Thoracoscopic Repair of Long-Gap Esophageal Atresia Using Internal Traction Is Safe and Feasible

2017 ◽  
Vol 27 (1) ◽  
pp. 71-75 ◽  
Author(s):  
Takahisa Tainaka ◽  
Hiroo Uchida ◽  
Akihide Tanano ◽  
Chiyoe Shirota ◽  
Akinari Hinoki ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Two Stage ◽  
Long Gap ◽  
Thoracoscopic Repair ◽  
Long Gap Esophageal Atresia

DOZ047.64: Sham feeding promotes oral feeding success in long-gap esophageal atresia, even with traction sutures in situ

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
A D Hawley ◽  
R K Armstrong ◽  
J-A E Brooks ◽  
A Pellicano ◽  
M G Nightingale ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Oral Feeding ◽  
Sham Feeding ◽  
Long Gap ◽  
Definitive Repair ◽  
Traction Suture ◽  
Long Gap Esophageal Atresia ◽  
Group 2 ◽  
Suture Placement ◽  
Group 1

Abstract Introduction Sham feeding (SF) and staged repair using traction suture techniques (TST) were both introduced to the management of long-gap esophageal atresia (LGOA) at The Royal Children's Hospital, Melbourne (RCH) in January 2012. Previous studies report SF to reduce time to full oral feeding (FOF) postdefinitive repair. In our practice, SF is individually tailored, supervised, and involves offering 2–4 feeds daily. This single-center experience describes SF in newborns with LGOA, including those with staged TST prior to definitive repair, and the impact of SF on time to FOF. Methods Patients admitted 2000–2018 with LGOA were identified from the Nate Myers Oesophageal Atresia Database, RCH. Those with incomplete data or complications preventing oral feeds were excluded. Patients were grouped into two epochs: Group 1 (2000–2011, no SF, no TST) and Group 2 (2012–2018, all offered SF, some TST). Demographics and time to FOF were compared between groups. Parametric data (mean, SD) were analyzed with two sample t-test, and nonparametric data (median, IQR) with Mann–Whitney test; P < 0.05 significant. Ethics approval was obtained (HREC#QA/51247/RCHM-2019). Results Of 37 LGOA patients, six met exclusion criteria leaving 31 for analysis; Group 1, n = 13; Group 2, n = 18. Groups did not differ in gestation (P = 0.63), birth weight (P = 0.91) or time to definitive repair (P = 0.85). In Group 2, 12/18 had successful SF, including 9 who underwent TST. Three additional patients with TST were unsuccessful with SF. Compared with Group 1, FOF was significantly reduced in those 12 patients with successful SF (median FOF 730 days, IQR 125–1100 vs. median FOF 75 days IQR 56–227; P = 0.03). Small sample size precluded meaningful subgroup analyses of successful versus unsuccessful SF patients. Importantly, no patient aspirated during SF, though one developed oral aversion post-TST and one ceased SF at parental request. Conclusions In LGOA, successful SF improves time to FOF postdefinitive repair, and was not associated with aspiration in our experience. Further, we report success with SF in patients undergoing staged repair with TST, including following traction suture placement. To our knowledge, this is the first report of SF in LGOA patients during the period between traction suture placement and definitive repair.

scholarly journals Thoracoscopic Esophageal Atresia with Tracheoesophageal Fistula Repair: The First Iranian Group Report, Passing the Learning Curve

2016 ◽  
Vol 5 (3) ◽  
pp. 29 ◽  
Author(s):  
Mehran Hiradfar ◽  
Mohammad Gharavifard ◽  
Reza Shojaeian ◽  
Marjan Joodi ◽  
Reza Nazarzadeh ◽  
...  
Keyword(s):  
Learning Curve ◽  
Esophageal Atresia ◽  
Conversion Rate ◽  
Tracheoesophageal Fistula ◽  
Point Of View ◽  
Thoracoscopic Approach ◽  
First Case ◽  
Thoracoscopic Repair ◽  
Esophageal Anastomosis ◽  
Overall Mortality

Background: Thoracoscopic treatment of esophageal atresia and tracheoesophageal fistula (EA+TEF) is accepted as a superior technique at least in cosmetic point of view but it is considered as an advance endoscopic procedure that needs a learning curve to be performed perfectly. This is the first report of Iranian group pediatric surgeons in thoracoscopic approach to EA.Methods & Materials: Since 2010, twenty four cases with EA+TEF underwent thoracoscopic approach in Sarvar children Hospital (Mashhad -Iran). During the first 6 months, thoracoscopic approach to 6 cases of EA+TEF was converted to open procedure because of technical and instrumental problems. The first case of successful thoracoscopic EA repair was accomplished in 2010 and since then, 10 cases of EA+ TEF among 18 patients were treated successfully with thoracoscopic approachResults: Overall conversion rate was 58.3% but conversion rate after the primary learning curve period, was 35.7%. The main conversion causes include difficulties in esophageal anastomosis, limited exposure and deteriorating the patient’s condition. Anastomotic leak and stenosis were observed in 20% and 40% respectively. Overall mortality rate was 4.2%.Conclusion: Thoracoscopic repair of esophageal atresia seems feasible and safe with considerable superiorities to the conventional method although acceptable results needs a prolonged learning curve and advanced endoscopic surgical skill. Clear judgment about the best surgical intervention for EA according to all cosmetic and functional outcomes needs further studies.

scholarly journals Current Controversies in the Surgical Treatment of Esophageal Atresia

2011 ◽  
Vol 100 (4) ◽  
pp. 273-278 ◽  
Author(s):  
J. A. Tovar ◽  
A. C. Fragoso
Keyword(s):  
Surgical Treatment ◽  
Esophageal Atresia ◽  
Rare Condition ◽  
Current Approach ◽  
Long Term Results ◽  
Esophageal Replacement ◽  
Thoracoscopic Approach ◽  
Long Gap ◽  
Thoracoscopic Repair ◽  
Difficult Cases

Background and Aims: Esophageal atresia (EA) with or without tracheo-esophageal fistula (TEF) is a rare condition that can be nowadays succesfully treated. The current interest therefore is focused on the management of the difficult cases, on thoracoscopic approach, and on some aspects of the long-term results. Methods: The current strategies for the difficult or impossible anastomoses in pure and long-gap EA, the introduction of thoracoscopic repair and the causes, mechanisms and management of post-operative gastro-esophageal reflux (GER) are reviewed. Results: Methods of esophageal elongation and multi-staged repair of pure and long-gap EA allow anastomosis but with functional results that are often poor. Esophageal replacement with colon or stomach achieves at least similar results and often requires less procedures. Thoracoscopic repair is a promising adjunct, but the difficulties for setting it as a gold-standard are pointed out. GER is a part of the disease and its surgical treatment, that is often required, is burdened by high failure rates. Conclusions: EA with or without TEF can be successfully treated in most cases, but a number of unsolved issues remain and the current approach to difficult cases will certainly evolve in the future.

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.

Sign in / Sign up

Export Citation Format

Share Document