Surgical repair of long-gap esophageal atresia: A retrospective study comparing the management of long-gap esophageal atresia in the Nordic countries

Abstract

Background: Several surgical procedures have been described in the reconstruction of long-gap esophageal atresia (LGEA). We reviewed the surgical methods used in children with LGEA in the Nordic countries over a 15-year period and the postoperative complications within the first postoperative year. Methods: Retrospective multicenter medical record review of all children born with Gross type A or B esophageal atresia between 01/01/2000 and 12/31/2014 reconstructed within their first year of life. Results: We included 71 children; 56 had Gross type A and 15 type B LGEA. Delayed primary anastomosis (DPA) was performed in 52.1% and an esophageal replacement procedure in 47.9%. Gastric pull-up (GPU) was the most frequent procedure (25.4%). The frequency of chromosomal abnormalities, congenital heart defects and other anomalies was significantly higher in patients who had a replacement procedure. The frequency of gastroesophageal reflux (GER) was significantly higher after DPA compared to esophageal replacement (p = 0.013). At 1year follow-up the mean body weight was higher after DPA than after organ interposition (p = 0.043). Conclusion: DPA and esophageal replacement procedures were equally applied. Postoperative complications and follow-up were similar except for the development of GER and the body weight at 1-year follow-up. Long-term results should be investigated.

Surgical treatment and major complications Within the first year of life in newborns with long-gap esophageal atresia gross type A and B – a systematic review

“…with an incidence on 27.0% [26]. One reason for GER after DPA may be the mobilization of the distal esophagus and the displacement of the gastroesophageal junction upward to the thoracic cavity [27].…”

“…The different incidences of GER in the different treatment groups may be hampered by a significant difference and inconsistence in the definition of GER. [26].…”

“…In this review and in our Nordic multi-center study [26] we focused on complications within the first postoperative year but long-term complications such as persistent GER, dysphagia and respiratory problems [30,31] should also be investigated to identify the most favorable surgical treatment for children born with…”

Usefulness of Gastrojejunostomy Prior to Fundoplication in Severe Gastro-Esophageal Reflux Complicating Long-Gap Esophageal Atresia Repair: A Preliminary Study

“…Long-gap esophageal atresia (LGEA) occurs in 10% of patients with esophageal atresia [1,2], and represents a challenge for surgical issues, post-operative sequelae, and comorbidities.…”

“…The incidence of symptomatic GERD is reported in more than 50% of cases [2], and it requires aggressive treatment. Fundoplication is considered the most common major surgical procedure in patients with LGEA [1,7,8].…”