Treatment and Follow-Up of Patients with Long-Gap Esophageal Atresia: 15 Years' of Experience from the Western Region of Sweden

Jönsson, Linus; Friberg, Lars Göran; Gatzinsky, Vladimir; Kötz, Karsten; Sillén, Ulla; Abrahamsson, Kate

doi:10.1055/s-0034-1396415

Cited by 9 publications

(3 citation statements)

References 29 publications

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“…Esophageal replacement (ER) surgery has been widely used in long-gap esophageal atresia (LGEA) over the past few decades. As a major indication, definition of “long-gap” varied from different studies [ 1 – 13 ] (Table 1 ). As there is no standard measure technique or specific numerical definition for the distance between the esophageal ends, “long-gap” was usually considered as “not possible for primary anastomosis or attempted but failed” in a functional way.…”

Section: Introductionmentioning

confidence: 99%

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

Liu

Yang²,

Zheng³

et al. 2017

Medicine

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Background:Esophageal replacement (ER) surgery has been widely used in long-gap esophageal atresia (LGEA) over the past few decades. The most commonly used surgical approaches in many pediatric surgical centers include colon interposition (CI), gastric pull-up (GPU), jejunal interposition (JI), and gastric tube reconstruction (GTR). However, there is no systematic evidence on which is the optimal conduit for the native esophagus. The aim of this systematic review was to evaluate the short- and long-term outcomes among these 4 replacement approaches in LGEA cases based on current evidence.Methods:PubMed, Web of Science, Cochrane Library, and EMBASE were searched for relevant literature on November 18 2016. Studies on ER in LGEA were reviewed and selected according to eligibility criteria. We focused on surgical outcomes regarding to different replacement approaches, including postoperative complications and long-term follow-up. Both detailed descriptions of single studies and pooled data analysis were conducted. Data were computed by Reviewer Manager 5.3.Results:Twenty-three studies were included (4 comparative retrospective, 3 prospective, and 16 retrospective) with a total of 593 patients (393 LGEA, 66.3%). The number of patients with available data for analysis was 534 (90.1%), including 127 patients (98 LGEA) of GPU, 335 (223 LGEA) of CI, 45 (all LGEA) of JI, and 27 (all LGEA) of GTR. Follow-up information was provided in 15 studies. Anastomotic leak and stricture, respiratory problems, and gastroesophageal reflux were analyzed as major postoperative complications. Long-term follow-ups were concentrated on growth and feeding conditions.Conclusion:Current evidence on short- and long-term outcomes of ER in LGEA patients was limited, and proper prospective comparative studies were lacking. This present systematic review indicates CI and GPU as comparable and favorable approaches, especially CI in the long-term outcomes. Studies on JI and GTR were limited, which need larger sample size to assess their validity and outcomes.

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Section: Introductionmentioning

confidence: 99%

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

Liu

Yang²,

Zheng³

et al. 2017

Medicine

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“…Gastrointestinal and respiratory morbidity have been investigated after primary anastomosis for EA [6][7][8][9][10][11]. Long term morbidity after primary EA repair has been considered to be moderate and QoL in adult patients has been demonstrated to be excellent [12][13].…”

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confidence: 99%

Quality of life after esophageal replacement in children

Gallo

Serooskerken

Tytgat

et al. 2021

Journal of Pediatric Surgery

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Assessing quality of life (QoL) after esophageal replacement (ER) for long gap esophageal atresia (LGEA). Methods: All patients after ER for LGEA with gastric pull-up (GPU n = 9) or jejunum interposition (JI n = 14) at the University Medical Center Groningen and Utrecht (1985-2007) were included. QoL was assessed with 1) gastrointestinal-related QoL using the Gastrointestinal Quality of Life Index (GIQLI)), 2) general QoL (Child Health questionnaire CHF87-BREF (children)/World Health Organization questionnaire WHOQOL-BREF (adults)), and 3) health-related QoL (HRQoL) (TNO AZL TACQoL/TAAQoL). Association of morbidity (heartburn, dysphagia, dyspnea on exertion, recurrent cough) and (HR)QoL was evaluated. Results: Six patients after GPU (75%) and eight patients after JI (57%) responded to the questionnaires (mean age 15.7, SD 5.9, 12 male, two female). Mean gastrointestinal, general and health-related QoL total scores of the patients were comparable to healthy controls. However, young adults reported a worse physical functioning (p = 0.02) but better social functioning compared to peers (p = 0.01). Morbidity was not associated with significant differences in (HR)QoL. Conclusions: With the current validated QoL most patients after ER with GPU and JI for LGEA have normal generic and disease specific QoL scores. Postoperative morbidity does not seem to influence (HR)QoL.

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“…Growth is an accepted standard for measuring child development and requires a normally functioning gastrointestinal tract together with its associated exocrine organs, liver and pancreas [17]. The CM is usually an isolated abnormality and there is no reason to think that such children will have a different growth potential or expectation from the normal population, unlike for example children born with gastroschisis, exomphalos or oesophageal atresia [18][19][20]. We therefore used SDS scores to compare with published normal values for weight and height and showed that there was indeed a lower weight SDS, and a similar trend for the height SDS prior to surgery.…”

Section: Discussionmentioning

confidence: 99%

Growth in children with choledochal malformations: effect of the Roux loop

2015

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Treatment and Follow-Up of Patients with Long-Gap Esophageal Atresia: 15 Years' of Experience from the Western Region of Sweden

Abstract: LGEA is a severe congenital malformation, with severe morbidity. No mortality was seen. MBW could be a useful tool for the early detection of progressive pulmonary damage.

Cited by 9 publications

References 29 publications

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

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

Quality of life after esophageal replacement in children

Growth in children with choledochal malformations: effect of the Roux loop

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