scholarly journals What is the Best Choice for Esophageal Replacement in Children?

2020 ◽  
pp. 1-5
Author(s):  
Ashjaei Bahar ◽  
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.

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

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 Surgical outcomes of different approaches to esophageal replacement in long-gap esophageal atresia

Medicine ◽  
2017 ◽  
Vol 96 (21) ◽  
pp. e6942 ◽  
Author(s):  
Jia Liu ◽  
Yifan Yang ◽  
Chao Zheng ◽  
Rui Dong ◽  
Shan Zheng
Keyword(s):  
Esophageal Atresia ◽  
Surgical Outcomes ◽  
Esophageal Replacement ◽  
Long Gap ◽  
Long Gap Esophageal Atresia

DOZ047.74: Long-term outcome of preserving the native esophagus in long-gap esophageal atresia by thoracoscopic traction technique

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
S H A J Tytgat ◽  
E S van Tuyll van Serooskerken ◽  
D C van der Zee ◽  
J W Verweij ◽  
M Y A Lindeboom
Keyword(s):  
Median Time ◽  
Esophageal Atresia ◽  
Oral Feeding ◽  
X Rays ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Gap ◽  
Anastomotic Strictures ◽  
Long Gap Esophageal Atresia

Abstract Background Long-gap esophageal atresia (LGEA) is defined as atresia without distal tracheoesophageal fistula. Preserving the native esophagus is considered superior over intestinal interposition. Thoracoscopic traction technique facilitates lengthening of the esophageal ends, and allows anastomosis within the first weeks of life. The aim of this study was to evaluate the long-term outcome of LGEA patients treated by thoracoscopic traction technique. Methods From 2007 to 2018, 13 consecutive patients with LGEA were treated by thoracoscopic traction technique. During the first operation a bronchoscopy was performed to evaluate the presence of a proximal fistula. Then thoracoscopic traction sutures were placed at both esophageal ends. Initially a gastrostomy was performed. However, nowadays only a gastropexy is performed to prevent the stomach from migrating into the thorax. Approximation of the esophageal ends was evaluated by postoperative X-rays. Thoracoscopic adhesiolysis was performed when necessary. Both ends were anastomosed during the final surgical procedure, usually within a week. Results In 11 patients the anastomosis could be completed by thoracoscopic traction technique. In two patients the elongation procedure failed. In the first patient the sutures tore out. The second patient had an accidental perforation of the proximal pouch by the Replogle tube. Median time on ventilation until after the final anastomosis was 14 days (range 4–34 days). Five patients required chest tube drainage for anastomotic leakage. The median hospitalization time during the first admission was 47 days (range 31–170 days). All patients needed a median of 4 (range 1–16) dilatations for anastomotic stenosis. Ten patients needed a fundoplication within a median time of 8 weeks (range 2–16 weeks) after the esophageal anastomosis. One patient developed an esophago-bronchial fistula. Median weight at age of 2 years was −1.88 SD (range −3.54 – −0.16) and at age of 4 years −1.53 SD (range −2.94–0.66). All patients tolerated full oral feeding. Conclusion LGEA can be treated successfully after elongation by thoracoscopic traction technique. The procedure leads to an earlier anastomosis and shorter initial hospital stay as compared to delayed primary anastomosis. Full oral feeding is possible in all patients. Dilatation for anastomotic strictures and antireflux surgery is necessary in (almost) all patients.

scholarly journals Favorable Outcome of Electively Delayed Elongation Procedure in Long-Gap Esophageal Atresia

2021 ◽  
Vol 8 ◽  
Author(s):  
Diez H. Oliver ◽  
Sidler Martin ◽  
Diez-Mendiondo I. Belkis ◽  
Wessel M. Lucas ◽  
Loff Steffan
Keyword(s):  
Gastroesophageal Reflux ◽  
Esophageal Atresia ◽  
Treatment Protocol ◽  
Esophageal Reconstruction ◽  
Stricture Formation ◽  
Term Outcome ◽  
Oral Nutrition ◽  
Long Gap ◽  
Lower Complication ◽  
Long Gap Esophageal Atresia

The ideal approach to long gap esophageal atresia is still controversial. On one hand, preserving a patient's native esophagus may require several steps and can be fraught with complications. On the other hand, most replacement procedures are irreversible and disrupt gastrointestinal physiology. The purpose of this study was to evaluate the short- and medium-term outcome of electively delayed esophageal elongation procedures before esophageal reconstruction in patients with long-gap esophageal atresia. Since the neonatal esophagus grows over-proportionally and can increase its wall thickness in the first few months of life, we hypothesized that postponing the elongation steps until 3 months of age would lead to a lower complication rate. We thus retrospectively recorded complications such as mediastinitis, anastomotic leakage, stricture formation, or gastroesophageal reflux requiring surgery, and compared it to reported outcomes. In our treatment protocol, patients born with long-gap esophageal atresia underwent gastrostomy placement and were sham fed until 3 months of age. We then assessed the gap between the esophageal ends and started serial elongation procedures. We only proceeded to the reconstruction of the esophagus when its length allowed a tension-free anastomosis. From April 2013 to April 2019, we treated 13 Patients with long-gap esophageal atresia. Nine patients without prior surgical procedures underwent Foker procedures. Four patients arrived with a pre-existing cervical esophagostomy and thus underwent Kimura's procedure, two of them with a concomitant Foker elongation of the lower pouch. Esophageal reconstruction was feasible in all patients, while none of them developed mediastinitis at any point in their treatment. We managed the only anastomotic leak conservatively. Almost half of the patients did not require any further intervention following reconstruction, while three patients required multiple (≥5) anastomotic dilatations. All but one patient achieved full oral nutrition. Only one child required a fundoplication to manage gastroesophageal reflux symptoms. Electively delayed esophageal elongation procedures in patients with long-gap esophageal atresia allowed preservation of the native esophagus in all patients. The approach had low peri-procedural morbidity, and patients enjoy favorable functional outcomes. Therefore, we suggest considering this method in the management of patients with long-gap esophageal atresia.

Gastric tube-pericardial fistula: a remote complication of esophageal replacement for long gap esophageal atresia

2009 ◽  
Vol 44 (7) ◽  
pp. 1440-1442 ◽  
Author(s):  
Alejandro R. Ruiz-Elizalde ◽  
Mary Jo Haley ◽  
Jason C. Fisher ◽  
Jason S. Frischer ◽  
Jeffrey L. Zitsman
Keyword(s):  
Esophageal Atresia ◽  
Gastric Tube ◽  
Esophageal Replacement ◽  
Long Gap ◽  
Long Gap Esophageal Atresia
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