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.

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.

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

The Current Thoracoscopic Management of Esophageal Atresia

2020 ◽  
Vol 30 (02) ◽  
pp. 142-145
Author(s):  
Jason D. Fraser ◽  
Shawn D. St Peter
Keyword(s):  
Minimally Invasive ◽  
Esophageal Atresia ◽  
Congenital Abnormality ◽  
Tracheoesophageal Fistula ◽  
Invasive Procedure ◽  
Minimally Invasive Procedure ◽  
Thoracoscopic Approach ◽  
Thoracoscopic Repair

AbstractThe thoracoscopic repair of esophageal atresia with tracheoesophageal fistula is a complex neonatal minimally invasive procedure. The thoracoscopic approach is now nearing its third decade of experience and but is overall still not widely utilized, only in skilled centers and by experienced surgeons. This article will summarize the recent advancements in technique and knowledge in the thoracoscopic approach to this challenging neonatal congenital abnormality.

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

Long gap esophageal atresia and esophageal replacement: moving toward a separation?

2004 ◽  
Vol 39 (7) ◽  
pp. 1084-1090 ◽  
Author(s):  
P Bagolan ◽  
B.D Iacobelli ◽  
P De Angelis ◽  
G Federici di Abriola ◽  
R Laviani ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Esophageal Replacement ◽  
Long Gap ◽  
Long Gap Esophageal Atresia

Outcome of thoracoscopic repair of type-C esophageal atresia: a single-center experience from North Africa

2020 ◽  
Vol 33 (7) ◽  
Author(s):  
Mohamed M Elbarbary ◽  
Aly Shalaby ◽  
Mohamed Elseoudi ◽  
Hamed M Seleim ◽  
Moutaz Ragab ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Esophageal Atresia ◽  
Operative Time ◽  
Anastomotic Stricture ◽  
Primary Anastomosis ◽  
Tertiary Care ◽  
Thoracoscopic Approach ◽  
Thoracoscopic Repair ◽  
Type C

Summary Thoracoscopic repair of esophageal atresia is gaining popularity worldwide attributable to availability and advances in minimally invasive instruments. In this report, we presented our experience with thoracoscopic esophageal atresia/tracheoesophageal fistula (EA/TEF) repair in our tertiary care institute. A prospective study on short-gap type-C EA/TEF was conducted at Cairo University Specialized Pediatric Hospital between April 2016 and 2018. Excluded were cases with birth weight < 1500 gm, inability to stabilize physiologic parameters, or major cardiac anomalies. The technique was standardized in all cases and was carried out by operating team concerned with minimally invasive surgery at our facility. Primary outcome evaluated was successful primary anastomosis. Secondary outcomes included operative time, conversion rate, anastomotic leakage, recurrent fistula, postoperative stricture, and time till discharge. Over the inclusion period of this study, 136 cases of EA/TEF were admitted at our surgical NICU. Thoracoscopic repair was attempted in 76 cases. In total, 30 cases were pure atresia/long gap type-C atresia and were excluded from the study. Remaining 46 cases met the inclusion criteria and were enrolled in the study. Mean age at operation was 8.7 days (range 2–32), and mean weight was 2.6 Kg (range 1.8–3.6). Apart from five cases (10.8%) converted to thoracotomy, the mean operative time was 108.3 minutes (range 80–122 minute). A tension-free primary anastomosis was possible in all thoracoscopically managed cases (n = 41) cases. Survival rate was 85.4% (n = 35). Anastomotic leakage occurred in seven patients (17%). Conservative management was successful in two cases, while esophagostomy and gastrostomy were judged necessary in the other for five. Anastomotic stricture developed in five cases (16.6%) of the 30 surviving patients who kept their native esophagus. Despite the fact that good mid-term presented results may be due to patient selection bias, thoracoscopic approach proved to be feasible for management of short-gap EA/TEF. Authors of this report believe that thoracoscopy should gain wider acceptance and pediatric surgeons should strive to adopt this procedure.

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