Long-gap oesophageal atresia: comparison of delayed primary anastomosis and oesophageal replacement with gastric tube

Lee, Hui Qing; Hawley, Alisa; Doak, Joe; Nightingale, Michael; Hutson, John M.

doi:10.1016/j.jpedsurg.2014.09.017

Cited by 46 publications

(34 citation statements)

References 20 publications

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“…[1][2][3][4] Common indications for the esophageal replacement procedure in children include long-gap esophageal atresia, severe peptic or caustic injuries, and anastomotic strictures. [5][6][7] The ideal esophageal substitute should closely imitate the native esophagus both in size and function; nevertheless, none can match a normal esophagus. 1,5 Several studies have reported comparable outcomes for each technique, with no significant differences in terms of their early and late complications.…”

Section: Introductionmentioning

confidence: 99%

Esophageal Replacement in Children: A 10-Year, Single-Center Experience

Laohapensang

Tangsriwong

Tantemsapya³

2019

Smj

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Objective: Various esophageal replacement grafts have been used in children, although none can equal the native esophagus. The purpose of this study was to review the complications and outcomes associated with using different techniques in a single institute. Methods: A retrospective medical record review was conducted from 2006 to 2016. Patient demographics, perioperative clinical courses, complications and long-term outcomes were reported as percentages and categorized according to the surgical procedure performed. Results: A total of 15 children underwent esophageal replacement procedures, comprising 7 (47%) isoperistaltic gastric tubes, 3 (20%) colonic interpositions, 3 (20%) gastric transpositions and 2 (13%) reversed gastric tubes. Indications for esophageal replacement included long-gap esophageal atresia (5; 33%), esophageal atresia with severe postoperative complications (6; 40%), and caustic injury (4; 27%).The mean age of patients was 2.9 years (range: 0.2-15 years). The average follow-up duration was 3.6 years (range: 0.4-8 years). There was no perioperative mortality and no graft loss in any group. The long-term outcomes were acceptable, with no late stricture. Eightysix percent of the patients in the isoperistaltic gastric tube group and all patients in the other procedural groups achieved full oral feeding. Nevertheless, the patients had various degrees of malnutrition. Conclusion: Esophageal replacement remains a major challenge in children. Our experience indicates that children can be safely operated on using any of these methods, with acceptable outcomes and no deaths. Nevertheless, the long-term consequences and complications should be monitored throughout adulthood.

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Section: Introductionmentioning

confidence: 99%

Esophageal Replacement in Children: A 10-Year, Single-Center Experience

Laohapensang

Tangsriwong

Tantemsapya³

2019

Smj

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“…Using these definitions, long gap OA occurs in 8‐10% of all cases of OA, or 1:40 000 live births . The surgical approach includes delayed primary anastomosis (at 3 months of age) with or without lengthening procedures such as the Foker procedure (traction suture oesophageal lengthening) or oesophageal replacement with gastric tube, gastric transposition, small bowel, or colonic transposition . Long gap OA has been identified as having distinct constellations of co‐morbidities and greater potential for long‐term hospitalization .…”

Section: Introductionmentioning

confidence: 99%

“…4 The surgical approach includes delayed primary anastomosis (at 3 months of age) with or without lengthening procedures such as the Foker procedure (traction suture oesophageal lengthening) or oesophageal replacement with gastric tube, gastric transposition, small bowel, or colonic transposition. [5][6][7][8][9] Long gap OA has been identified as having distinct constellations of co-morbidities and greater potential for longterm hospitalization. 4,[10][11][12] Anesthetic management of OA is challenging especially in infants with a distal tracheoesophageal fistula where preferential ventilation of the fistula may cause profound hypoxia and potentially gastric perforation.…”

Section: Introductionmentioning

confidence: 99%

Oesophageal atresia: Are “long gap” patients at greater anesthetic risk?

Powell

Frawley

Crameri

et al. 2018

Pediatric Anesthesia

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“…[10] сообщают, что этапное лечение АП у младенцев с массой тела при рождении менее 1500 г способствовало возникновению меньшего количества осложнений в зоне анастомоза и уменьшению показателя смертности [10]. Таким образом, препятствиями к выполнению первичного анастомоза, по мнению многих авторов, являются большой диастаз между сегментами пищевода, сопутствующие аномалии развития и очень низкая масса тела при рождении [4][5][6][7][8][9][10][11][12][13][14]. В таких ситуациях показано выполнение отсроченного эзофаго-эзофагоанастомоза или замена пищевода толстой кишкой или желудком.…”

Section: Discussionunclassified

“…При этом пороке развития операцией выбора является выполнение первичного анастомоза пищевода. Однако, по мнению многих авторов, большой диастаз между сегментами пищевода, сопутствующие аномалии и масса тела менее 1500 г служат препятствиями к наложению первичного анастомоза [4][5][6][7][8][9][10][11][12][13][14]. В подобных ситуациях показано выполнение отсроченного эзофаго-эзофагоанастомоза или замена пищевода толстой кишкой или желудком.…”

Section: Introductionunclassified