International Survey on the Management of Esophageal Atresia

Augusto Zani; Simon Eaton; Michael E. Hoellwarth; Prem Puri; Juan Tovar; Guenter Fasching; Pietro Bagolan; Marija Lukac; Rene Wijnen; Joachim F. Kuebler; Giovanni Cecchetto; Risto Rintala; Agostino Pierro

doi:10.1055/s-0033-1350058

European Journal of Pediatric Surgery, Table of Contents

Eur J Pediatr Surg 2014; 24(01): 003-008
DOI: 10.1055/s-0033-1350058

Original Article

Georg Thieme Verlag KG Stuttgart · New York

International Survey on the Management of Esophageal Atresia

Augusto Zani

¹Department of Pediatric Surgery, University College London Institute of Child Health, London, United Kingdom

²Department of Pediatric Surgery, Sapienza University of Rome, Rome, Italy

,

Simon Eaton

¹Department of Pediatric Surgery, University College London Institute of Child Health, London, United Kingdom

,

Michael E. Hoellwarth

³Department of Pediatric and Adolescents Surgery, Medical University of Graz, Graz, Austria

,

Prem Puri

⁴Department of Pediatric Surgery, National Children's Research Centre, Dublin, Ireland

,

Juan Tovar

⁵Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain

,

Guenter Fasching

⁶Department of Pediatric Surgery, Klagenfurt General Hospital, Klagenfurt, Austria

,

Pietro Bagolan

⁷Neonatal Surgery Unit, Bambino Gesù Children's Research Hospital, Rome, Italy

,

Marija Lukac

⁸Department of Pediatric Surgery, Faculty of Medicine, University Children's Hospital, Belgrade, Serbia

,

Rene Wijnen

⁹Department of Pediatric Surgery, Erasmus MC, Sophia in Erasmus MC Sophia Childrens' Hospital, Rotterdam, The Netherlands

,

Joachim F. Kuebler

¹⁰Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany

,

Giovanni Cecchetto

¹¹Department of Pediatric Surgery, University Hospital of Padua, Padova, Italy

,

Risto Rintala

¹²Department of Pediatric Surgery, Hospital for Children and Adolescents, Helsinki, Finland

,

Agostino Pierro

¹Department of Pediatric Surgery, University College London Institute of Child Health, London, United Kingdom

¹³Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Canada

› Author Affiliations

Abstract

Introduction Because many aspects of the management of esophageal atresia (EA) are still controversial, we evaluated the practice patterns of this condition across Europe.

Methods A survey was completed by 178 delegates (from 45 [27 European] countries; 88% senior respondents) at the EUPSA-BAPS 2012.

Results Approximately 66% of respondents work in centers where more than five EA repairs are performed per year. Preoperatively, 81% of respondents request an echocardiogram, and only 43% of respondents routinely perform preoperative bronchoscopy. Approximately 94% of respondents prefer an open approach, which is extrapleural in 71% of respondents. There were no differences in use of thoracoscopy between Europeans (10%) and non-Europeans (11%, p = nonsignificant). Approximately 60% of respondents measure the gap intraoperatively. A transanastomotic tube (90%) and chest drain (69%) are left in situ. Elective paralysis is adopted by 56% of respondents mainly for anastomosis tension (65%). About 72% of respondents routinely request a contrast study on postoperative day 7 (2–14). Approximately 54% of respondents use parenteral nutrition, 40% of respondents start transanastomotic feeds on postoperative day 1, and 89% of respondents start oral feeds after postoperative day 5. Pure EA: 46% of respondents work in centers that repair two or more than two pure EA a year. About 60% of respondents opt for delayed primary anastomosis at 3 months (1–12 months) with gastrostomy formation without esophagostomy. Anastomosis is achieved with open approach by 85% of respondents. About 47% of respondents attempt elongation of esophageal ends via Foker technique (43%) or with serial dilations with bougies (41%). Approximately 67% of respondents always attempt an anastomosis. Gastric interposition is the commonest esophageal substitution.

Conclusion Many aspects of EA management are lacking consensus. Minimally invasive repair is still sporadic. We recommend establishment of an EA registry.

Keywords

esophageal atresia - thoracoscopy - pure esophageal atresia - esophageal replacement - Europe

Full Text

References

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