Foker process for the correction of long gap esophageal atresia: Primary treatment versus secondary treatment after prior esophageal surgery

Bairdain, Sigrid; Hamilton, Thomas E.; Smithers, C. Jason; Manfredi, Michael A.; Ngo, Peter; Gallagher, Dorothy; Zurakowski, David; Foker, John E.; Jennings, Russell W.

doi:10.1016/j.jpedsurg.2015.03.010

Cited by 64 publications

(48 citation statements)

References 14 publications

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“…A parent or legal-guardian of each subject attested to informed consent for study participation. Patients' eligibility criteria were: full-term (37 to 42 weeks GA at birth) and moderate-to-late preterm (28 to 36 weeks GA at birth) patients <1 year gestation-corrected age that underwent surgery for Foker process for LGEA repair 1,22 . We selected infants that required prolonged postoperative sedation (≥5 days) associated with development of pharmacological dependence to drugs of sedation 11,[23][24][25] .…”

Section: Methodsmentioning

confidence: 99%

Infant Corpus Callosum Size After Surgery and Critical Care for Long-Gap Esophageal Atresia: Qualitative and Quantitative MRI

Mongerson

Jaimes

Zurakowski

et al. 2020

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previous studies in preterm infants report white matter abnormalities of the corpus callosum (cc) as an important predictor of neurodevelopmental outcomes. our cross-sectional study aimed to describe qualitative and quantitative cc size in critically ill infants following surgical and critical care for longgap esophageal atresia (LGeA)-in comparison to healthy infants-using MRi. non-sedated brain MRi was acquired for full-term (n = 13) and premature (n = 13) patients following treatment for LGEA, and controls (n = 20) <1 year corrected age. A neuroradiologist performed qualitative evaluation of T1weighted images. ITK-SNAP was used for linear, 2-D and 3-D manual CC measures and segmentations as part of CC size quantification. Qualitative MRI analysis indicated underdeveloped CC in both patient groups in comparison to controls. We show no group differences in mid-sagittal CC length. Although 2-D results were inconclusive, volumetric analysis showed smaller absolute (F(2,42) = 20.40, p < 0.001) and normalized (F(2,42) = 16.61, p < 0.001) CC volumes following complex perioperative treatment for LGeA in both full-term and premature patients, suggesting delayed or diminished cc growth in comparison to controls, with no difference between patient groups. Future research should look into etiology of described differences, neurodevelopmental outcomes, and role of the CC as an early marker of neurodevelopment in this unique infant population.

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Section: Methodsmentioning

confidence: 99%

Infant Corpus Callosum Size After Surgery and Critical Care for Long-Gap Esophageal Atresia: Qualitative and Quantitative MRI

Mongerson

Jaimes

Zurakowski

et al. 2020

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“…All other forms of EA as well as those who did not undergo the Foker process (FP) were excluded. Primary LGEA patients were those patients who did not undergo a previous operation or whose previous operations were limited to a gastrostomy placement while those patients who had esophageal surgery elsewhere were considered secondary FP cases (Bairdain et al, In Press). …”

Section: Methodsmentioning

confidence: 99%

“…Long-Gap Esophageal Atresia (LGEA) is a rare congenital anomaly and frequently requires utilization of interventions that may expose infant patients to increased fracture risk (David and O'Callaghan, 1975, Bairdain et al, 2014, Bairdain et al, In Press). LGEA is often defined by a distance between the upper and a lower atretic esophageal segment of greater than three vertebral bodies (Gross, 1953, Foker et al, 1997).…”

Section: Introductionmentioning

confidence: 99%

“…The degree and length of exposure to these aforementioned entities is proportional to the difficulty of the repair. As a referral center for LGEA, Boston Children's Hospital (BCH) provides a unique environment to evaluate the potential effects of exposure to certain interventions and the development of inpatient fractures (Bairdain et al, In Press). Therefore, we aimed to identify factors associated with increased risk of fractures in LGEA patients undergoing the Foker process.…”

Section: Introductionmentioning

confidence: 99%

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High incidence of fracture events in patients with Long-Gap Esophageal Atresia (LGEA): A retrospective review prompting implementation of standardized protocol

et al. 2015

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PurposeTo identify factors associated with an increased risk of fractures in Long-Gap Esophageal Atresia (LGEA) patients. Following implementation of a risk-stratified program, we hypothesized a reduction in fracture incidence within this potentially high-risk population.MethodsA retrospective review of LGEA-patients admitted between 2005 and 2014 was conducted. Symptomatic fractures with radiographic confirmation were defined as events. Univariate and multivariable analysis evaluated factors including admission weight-for-age z-score, primary versus secondary Foker process (FP), weight at Foker Stage I, days and episodes of paralysis, number of parenteral nutrition (PN) days, cumulative dose of loop diuretics adjusted for body weight and days exposed, and exposure to non-loop diuretics. A fracture-prevention protocol was initiated in 2012; incidence was evaluated pre and post-intervention.ResultsFifty-nine patients met inclusion criteria. Twenty-three (39%) patients in the entire cohort incurred at least one fracture during their hospitalization utilizing the Foker process. Given this high percentage, a targeted fracture-prevention protocol was initiated in 2012. Fracture incidence decreased from 48% prior to the protocol to 21% following the protocol (P = 0.046). Several variables that were associated with an increased risk of fractures on univariate analysis included prior esophageal anastomosis attempt (P = 0.008), number of separate episodes of paralysis (P = 0.002), exposure to non-loop diuretics (P = 0.006), cumulative loop diuretic dose (P < 0.001), as well as cumulative loop diuretic over days exposed (P < 0.001). Intensive care unit (ICU) stay (P = 0.002) and total length of hospitalization (P < 0.001) were also significantly longer among patients with a fracture. Number of separate episodes of paralysis was the only independent risk factor for the development of a fracture; patients having more than 3 episodes of paralysis had an estimated risk of fracture 15 times higher than those patients paralyzed only once or twice (O.R. 15.87, 95% C.I.: 1.47–171.23, P = 0.008).ConclusionEpisodes of paralysis appeared to be the most significant risk factor for fractures in patients with LGEA who underwent the Foker procedure. The incidence of symptomatic fractures decreased significantly following implementation of a standardized protocol in this series of LGEA patients with continued prospective evaluation.

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“…In long-gap EA, successful repair with the native esophagus is possible at least in half of the patients 1 and ingenious techniques such as esophageal lengthening by traction may enable the use of native esophagus in still greater part of patients with long-gap EA. 2,3 Sometimes, however, the shortness or poor Introduction Several surgical techniques are available for pediatric esophageal reconstruction. We started to use pedicled jejunum interposition graft (PJIG) because other techniques had significant long-term complications.…”

Section: Introductionmentioning

confidence: 99%

Indications, Surgical Complications, and Long-Term Outcomes in Pediatric Esophageal Reconstructions with Pedicled Jejunal Interposition Graft

et al. 2020

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Introduction Several surgical techniques are available for pediatric esophageal reconstruction. We started to use pedicled jejunum interposition graft (PJIG) because other techniques had significant long-term complications. In this retrospective study, the indications, surgical complications, and long-term outcomes were assessed in patients with PJIG. Materials and Methods With ethical consent, we reviewed the hospital records of 14 patients (7 females) who from 2005 to 2019 underwent a total of 16 esophageal reconstructions with PJIG. Results Median age at PJIG was 1.6 (range: 0.2–15) years. Underlying conditions were esophageal atresia (EA) (n = 11) or native esophagus lost by trauma or infection (n = 3). Eight patients with EA underwent PJIG as primary reconstruction and three as a rescue operation after complications in primary repair. Significant surgical complications occurred in 43% of patients. Major reoperations in six (43%) patients included resection and reanastomosis of strictured proximal PJIG (n = 1) and redo PJIG after failure of the first operation (n = 2). Surgical mortality was nil. After a median follow-up of 6.5 (range: 0.7–14) years, 13 (93%) patients survived, and 1 died of congenital heart disease. PJIG failed in three (23%) survivors of whom two underwent graft removal because of life-threatening aspiration and one did not start oral feeds at all. Ten survivors (77%) have full enteral feeds. Respiratory function in the survivors is satisfactory. Two patients have moderate and three mild gastroesophageal reflux symptoms. Conclusion PJIG was a functional option for a variety of conditions that required esophageal reconstruction. However, significant early and late complications required major surgical revisions.

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Foker process for the correction of long gap esophageal atresia: Primary treatment versus secondary treatment after prior esophageal surgery

Cited by 64 publications

References 14 publications

Infant Corpus Callosum Size After Surgery and Critical Care for Long-Gap Esophageal Atresia: Qualitative and Quantitative MRI

Infant Corpus Callosum Size After Surgery and Critical Care for Long-Gap Esophageal Atresia: Qualitative and Quantitative MRI

High incidence of fracture events in patients with Long-Gap Esophageal Atresia (LGEA): A retrospective review prompting implementation of standardized protocol

Indications, Surgical Complications, and Long-Term Outcomes in Pediatric Esophageal Reconstructions with Pedicled Jejunal Interposition Graft

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