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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
› Institutsangaben
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.
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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


Publikationsverlauf

Eingereicht: 16. Mai 2023

Angenommen: 08. Dezember 2023

Accepted Manuscript online:
28. Dezember 2023

Artikel online veröffentlicht:
22. Januar 2024

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