Download PDF
Eur J Pediatr Surg 2024; 34(01): 036-043
DOI: 10.1055/a-2235-8766
Original Article

Thoracoscopic Stage Internal Traction Repair Reduces Time to Achieve Esophageal Continuity in Long Gap Esophageal Atresia

Dominika Borselle 
1   Department of Paediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland
,
Joseph Davidson
2   Great Ormond Street Institute of Child Health, University College London, London, United Kingdom of Great Britain and Northern Ireland
,
Stavros Loukogeorgakis
2   Great Ormond Street Institute of Child Health, University College London, London, United Kingdom of Great Britain and Northern Ireland
3   Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, NIHR, London, United Kingdom of Great Britain and Northern Ireland
,
Paolo De Coppi 
2   Great Ormond Street Institute of Child Health, University College London, London, United Kingdom of Great Britain and Northern Ireland
3   Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, NIHR, London, United Kingdom of Great Britain and Northern Ireland
,
Dariusz Patkowski
1   Department of Paediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland
› Author Affiliations Funding S.L., J.D., and P.D.C. acknowledge support from the Great Ormond Street NIHR Biomedical Research Centre. They acknowledge the surgical contribution to the series of the Specialist Neonatal and Pediatric Surgery Department at Great Ormond Street Hospital. D.B. and D.P. acknowledge support from the Wroclaw Medical University. They acknowledge the surgical contribution to the series of the Department of Pediatric Surgery and Urology at University Hospital in Wroclaw, Poland.
› Further Information
    Permissions and Reprints


Abstract

Objective Management of long gap esophageal atresia (LGOA) is controversial. This study aims at comparing the management of LGOA between two high-volume centers.

Methods We included patients with LGOA (type A and B) between 2008 and 2022. Demographics, surgical methods, and outcomes were collected and compared.

Results The study population involved 28 patients in center A and 24 patients in center B. A surgical approach was thoracoscopic in center A, only for one patient was open for final procedure. In center B, 3 patients were treated only thoracoscopically, 2 converted to open, and 19 as open surgery. In center A primary esophageal anastomosis concerned 1 case, two-staged esophageal lengthening using external traction 1 patient, and 26 were treated with the multistaged internal traction technique. In 24 patients a full anastomosis was achieved: in 23 patients only the internal traction technique was used, while 1 patient required open Collis–Nissen procedure as final management. In center B primary anastomosis was performed in 7 patients, delayed esophageal anastomosis in 8 patients, esophageal lengthening using external traction in 1 case, and 9 infants required esophageal replacement with gastric tube. Analyzed postoperative complications included: early mortality, 2/28 due to accompanied malformations (center A) and 0/24 (center B); anastomotic leakage, 4/26 (center A) treated conservatively—all patients had a contrast study—and 0/24 (center B), 1 case of pleural effusion, but no routine contrast study; recurrent strictures, 13/26 (center A) and 7/15 (center B); and need for fundoplication, 5/26 (center A) and 2/15 (center B). Age at esophageal continuity was as a median of 31 days in center A and 110 days in center B. Median time between initial procedure and esophageal anastomosis was 11 days in center A and 92 days in center B.

Conclusion Thoracoscopic internal traction technique reduces time to achieve esophageal continuity and the need for esophageal substitution while maintaining a similar early complication rate.

Keywords

long gap esophageal atresia - esophageal atresia - internal traction - minimally invasive surgery - delayed primary anastomosis


Publication History

Received: 16 May 2023

Accepted: 08 December 2023

Accepted Manuscript online:
28 December 2023

Article published online:
22 January 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 van der Zee DC, Bagolan P, Faure C. et al. Position paper of INoEA working group on long gap esophageal atresia: for better care. Front Pediatr 2017; 5: 63
    CrossrefPubMedGoogle Scholar
  • 2 Baird R, Lal DR, Ricca RL. et al. Management of long gap esophageal atresia: a systematic review and evidence-based guidelines from the APSA Outcomes and Evidence Based Practice Committee. J Pediatr Surg 2019; 54 (04) 675-687
    CrossrefPubMedGoogle Scholar
  • 3 Dingemann C, Eaton S, Aksnes G. et al. ERNICA consensus conference on the management of patients with long-gap esophageal atresia: perioperative, surgical, and long-term management. Eur J Pediatr Surg 2021; 31 (03) 214-225
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Patkowski D. Intrathoracic intracorporeal thoracoscopic elongation – internal traction. In: Pimpalwar A. ed. Esophageal Preservation and Replacement in Children. Cham, Switzerland: Springer Nature; 2021: 51-56
    Google Scholar
  • 5 Ron O, De Coppi P, Pierro A. The surgical approach to esophageal atresia repair and the management of long-gap atresia: results of a survey. Semin Pediatr Surg 2009; 18 (01) 44-49
    CrossrefPubMedGoogle Scholar
  • 6 Rothenberg SS, Flake AW. Experience with thoracoscopic repair of long gap esophageal atresia in neonates. J Laparoendosc Adv Surg Tech A 2015; 25 (11) 932-935
    CrossrefPubMedGoogle Scholar
  • 7 Spitz L. Esophageal atresia. Lessons I have learned in a 40-year experience. J Pediatr Surg 2006; 41 (10) 1635-1640
    PubMedGoogle Scholar
  • 8 Lee HQ, Hawley A, Doak J, Nightingale MG, Hutson JM. Long-gap oesophageal atresia: comparison of delayed primary anastomosis and oesophageal replacement with gastric tube. J Pediatr Surg 2014; 49 (12) 1762-1766
    CrossrefPubMedGoogle Scholar
  • 9 Koivusalo A, Suominen J, Rintala R, Pakarinen M. Location of TEF at the carina as an indicator of long-gap C-type esophageal atresia. Dis Esophagus 2018; 31 (11) DOI: 10.1093/dote/doy044.
    CrossrefPubMedGoogle Scholar
  • 10 Patkowski D. Thoracoscopic approach for oesophageal atresia: a real game changer?. J Pediatr Surg 2023; 58 (02) 204-208
    CrossrefPubMedGoogle Scholar
  • 11 Myers NA. Oesophageal atresia: the epitome of modern surgery. Ann R Coll Surg Engl 1974; 54 (06) 277-287
    PubMedGoogle Scholar
  • 12 Zani A, Eaton S, Hoellwarth ME. et al. International survey on the management of esophageal atresia. Eur J Pediatr Surg 2014; 24 (01) 3-8
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Zani A, Cobellis G, Wolinska J, Chiu PP, Pierro A. Preservation of native esophagus in infants with pure esophageal atresia has good long-term outcomes despite significant postoperative morbidity. Pediatr Surg Int 2016; 32 (02) 113-117
    CrossrefPubMedGoogle Scholar
  • 14 Friedmacher F. Delayed primary anastomosis for repair of long-gap esophageal atresia: technique revisited. Pediatr Surg Int 2022; 39 (01) 40
    CrossrefPubMedGoogle Scholar
  • 15 Puri P, Blake N, O'Donnell B, Guiney EJ. Delayed primary anastomosis following spontaneous growth of esophageal segments in esophageal atresia. J Pediatr Surg 1981; 16 (02) 180-183
    CrossrefPubMedGoogle Scholar
  • 16 Puri P, Ninan GK, Blake NS, Fitzgerald RJ, Guiney EJ, O'Donnell B. Delayed primary anastomosis for esophageal atresia: 18 months' to 11 years' follow-up. J Pediatr Surg 1992; 27 (08) 1127-1130
    CrossrefPubMedGoogle Scholar
  • 17 Boyle Jr EM, Irwin ED, Foker JE. Primary repair of ultra-long-gap esophageal atresia: results without a lengthening procedure. Ann Thorac Surg 1994; 57 (03) 576-579
    CrossrefPubMedGoogle Scholar
  • 18 Spitz L. Esophageal replacement: overcoming the need. J Pediatr Surg 2014; 49 (06) 849-852
    CrossrefPubMedGoogle Scholar
  • 19 Foker JE, Kendall Krosch TC, Catton K, Munro F, Khan KM. Long-gap esophageal atresia treated by growth induction: the biological potential and early follow-up results. Semin Pediatr Surg 2009; 18 (01) 23-29
    CrossrefPubMedGoogle Scholar
  • 20 van der Zee DC, Vieirra-Travassos D, Kramer WL, Tytgat SH. Thoracoscopic elongation of the esophagus in long gap esophageal atresia. J Pediatr Surg 2007; 42 (10) 1785-1788
    CrossrefPubMedGoogle Scholar
  • 21 van der Zee DC, Gallo G, Tytgat SH. Thoracoscopic traction technique in long gap esophageal atresia: entering a new era. Surg Endosc 2015; 29 (11) 3324-3330
    CrossrefPubMedGoogle Scholar
  • 22 Bogusz B, Patkowski D, Gerus S, Rasiewicz M, Górecki W. Staged thoracoscopic repair of long-gap esophageal atresia without temporary gastrostomy. J Laparoendosc Adv Surg Tech A 2018; 28 (12) 1510-1512
    CrossrefPubMedGoogle Scholar
  • 23 Penikis AB, Salvi PS, Sferra SR. et al. Delayed primary repair in 100 infants with isolated long-gap esophageal atresia: a nationwide analysis of children's hospitals. Surgery 2023; 173 (06) 1447-1451
    CrossrefPubMedGoogle Scholar
  • 24 Dellenmark-Blom M, Örnö Ax S, Öst E. et al. Postoperative morbidity and health-related quality of life in children with delayed reconstruction of esophageal atresia: a nationwide Swedish study. Orphanet J Rare Dis 2022; 17 (01) 239
    CrossrefPubMedGoogle Scholar
  • 25 Patterson K, Beyene TJ, Asti L, Althubaiti A, Lind M, Pattisapu P. Quantifying upper aerodigestive sequelae in esophageal atresia/tracheoesophageal fistula neonates. Laryngoscope 2022; 132 (03) 695-700
    CrossrefPubMedGoogle Scholar
  • 26 Bourg A, Gottrand F, Parmentier B. et al. Outcome of long gap esophageal atresia at 6 years: a prospective case control cohort study. J Pediatr Surg 2023; 58 (04) 747-755
    CrossrefPubMedGoogle Scholar
  • 27 Gunn-Charlton JK. Impact of comorbid prematurity and congenital anomalies: a review. Front Physiol 2022; 13: 880891
    CrossrefPubMedGoogle Scholar
  • 28 Keefe G, Culbreath K, Edwards EM. et al. Current outcomes of infants with esophageal atresia and tracheoesophageal fistula: a multicenter analysis. J Pediatr Surg 2022; 57 (06) 970-974
    CrossrefPubMedGoogle Scholar
  • 29 Jackson HT, Kane TD. Advances in minimally invasive surgery in pediatric patients. Adv Pediatr 2014; 61 (01) 149-195
    CrossrefPubMedGoogle Scholar
  • 30 Bastard F, Bonnard A, Rousseau V. et al. Thoracic skeletal anomalies following surgical treatment of esophageal atresia. Lessons from a national cohort. J Pediatr Surg 2018; 53 (04) 605-609
    CrossrefPubMedGoogle Scholar
  • 31 Lawal TA, Gosemann JH, Kuebler JF, Glüer S, Ure BM. Thoracoscopy versus thoracotomy improves midterm musculoskeletal status and cosmesis in infants and children. Ann Thorac Surg 2009; 87 (01) 224-228
    CrossrefPubMedGoogle Scholar
  • 32 Holcomb III GW, Rothenberg SS, Bax KMA. et al. Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula: a multi-institutional analysis. Ann Surg 2005; 242 (03) 422-428 , discussion 428–430
    CrossrefPubMedGoogle Scholar
  • 33 Onishi S, Muto M, Yamada K. et al. Feasibility of delayed anastomosis for long gap esophageal atresia in the neonatal period using internal traction and indocyanine green-guided near-infrared fluorescence. Asian J Endosc Surg 2022; 15 (04) 877-881
    CrossrefPubMedGoogle Scholar
  • 34 Subramaniam T, Martin BP, Jester I. et al. A single centre experience using internal traction sutures in managing long gap oesophageal atresia. J Pediatr Surg 2022; 57 (11) 516-519
    CrossrefPubMedGoogle Scholar
  • 35 Brennan K, Cullis P, Yardley I. Children's Upper Gastrointestinal Surgery (ChUGS) Network. Oesophageal lengthening by traction in oesophageal atresia: the UK experience. J Pediatr Surg 2022; 57 (02) 187-191
    CrossrefPubMedGoogle Scholar
  • 36 Maghsoudlou P, Eaton S, De Coppi P. Tissue engineering of the esophagus. Semin Pediatr Surg 2014; 23 (03) 127-134
    CrossrefPubMedGoogle Scholar
  • 37 Perin S, McCann CJ, Borrelli O, De Coppi P, Thapar N. Update on foregut molecular embryology and role of regenerative medicine therapies. Front Pediatr 2017; 5: 91
    CrossrefPubMedGoogle Scholar
  • 38 Ure B. Esophageal atresia, Europe, and the future: BAPS Journal of Pediatric Surgery Lecture. J Pediatr Surg 2019; 54 (02) 217-222
    CrossrefPubMedGoogle Scholar