Primary repair of esophageal atresia: How long a gap?

Howell, Charles G.; Davis, Julianne; Parrish, Robert A.

doi:10.1016/s0022-3468(87)80012-x

Cited by 19 publications

(4 citation statements)

References 9 publications

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“…The best management in children with long gap EA is still undetermined, but children whose oesophagus is preserved seem to have a better long-term outcome in relation to swallowing and GOR related symptoms [18]. At present, most paediatric surgeons agree that delayed oesophageal anastomosis with an end-to-end anastomosis is the procedure of choice in the management of pure EA as it offers the most physiological reconstruction possible [16,23,24].…”

Section: Discussionmentioning

confidence: 99%

Long-term results of delayed primary anastomosis for pure oesophageal atresia: a 27-year follow up

Paran

DeCaluwe²,

Corbally³

et al. 2007

Pediatr Surg Int

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The management of a newborn with pure oesophageal atresia continues to be challenging. We started treating babies with pure oesophageal atresia by delayed primary anastomosis in 1977. The purpose of this study was to review the long-term outcome in infants with pure oesophageal atresia (EA) treated by delayed primary anastomosis with special emphasis on gastroesophageal reflux (GOR) related morbidity. The medical charts of all patients treated by delayed primary anastomosis between 1977 and 2004 were retrospectively reviewed. All survivors were followed up with completion of a questionnaire and personal/phone interviews. There were 26 patients in total admitted during the 27-year study period with the diagnosis of pure oesophageal atresia. Three died prior to surgery due to associated anomalies; two had almost no distal oesophageal segment and underwent oesophageal replacement surgery. The remaining 21 children were treated with delayed primary anastomosis and made up our study group. There were four deaths (19%) in this group, and all were prior to 1980. The median gestational age was 35.5 weeks and the median birth weight was 2.6 kg; median initial gap was 3.7 cm and median preoperative gap was 1.5 cm; median age at operation was 80 days and the median hospital stay was 5.5 months. The median follow-up period was 13.5 years. Fourteen children (66%) developed symptomatic gastroesophageal reflux and nine of these needed fundoplication (43%). Sixteen children developed strictures at the anastomotic site; ten responded to repeated dilatations while six needed resection and reanastomosis. At the time of this study, 15 out of the 17 survivors (88%) were on normal diet with no respiratory problems and 2 (12%) were dependent on gastrostomy feeds. Our long-term follow-up data shows that the delayed primary anastomosis provides excellent functional results in patients born with pure oesophageal atresia. The high incidence of gastroesophageal reflux and associated morbidity requires early intervention to prevent ongoing feeding problems due to oesophagitis and stricture formation.

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Section: Discussionmentioning

confidence: 99%

Long-term results of delayed primary anastomosis for pure oesophageal atresia: a 27-year follow up

Paran

DeCaluwe²,

Corbally³

et al. 2007

Pediatr Surg Int

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“…The correct timing would be uncertain, although some reports refer to successfully treated cases by primary esophageal anastomosis, with initial gaps as long as 8 vertebral segments and with delays of up to 7 months. [4][5] Complications involving the esophageal pouch suction, mainly related with the possibility of aspiration episodes, were of concern as well. 1 Therefore, assuming that spontaneous growth of the esophagus occurs predominantly during the first 3 months of life, we planned the thoracotomy at about this age.…”

Section: Discussionmentioning

confidence: 99%

Very long gap esophageal atresia successfully treated by esophageal lengthening using external traction sutures

Lopes¹,

Reis²,

Coutinho³

et al. 2004

Journal of Pediatric Surgery

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“…The two oesophageal segments were elongated by daily bougienage of the proximal and eventually the distal end over several months. At operation, the gap was 1 cm and a myotomy of the upper pouch was necessary to perform the anastomosis (8).…”

Section: Discussionmentioning

confidence: 99%

Foker's Technique in Oesophageal Atresia with Double Fistula: A Case Report

Gaglione

Tramontano²,

Capobianco³

et al. 2003

Eur J Pediatr Surg

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The authors' starting point is a new surgical approach described by Foker and performed by them on a newborn with long-gap oesophageal atresia. We discuss the possibility of obtaining rapid growth of the atretic oesophagus and performing a primary anastomosis in the case of long-gap oesophageal atresia. With this procedure, primary oesophageal repair could be performed without myotomies, without flaps and with the gastrooesophageal junction below the diaphragm. The need for gastrostomy would be also eliminated if the patient underwent the operation as a neonate.

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Primary repair of esophageal atresia: How long a gap?

Cited by 19 publications

References 9 publications

Long-term results of delayed primary anastomosis for pure oesophageal atresia: a 27-year follow up

Long-term results of delayed primary anastomosis for pure oesophageal atresia: a 27-year follow up

Very long gap esophageal atresia successfully treated by esophageal lengthening using external traction sutures

Foker's Technique in Oesophageal Atresia with Double Fistula: A Case Report

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