Experience of secondary multistage treatment for complex long gap esophageal atresia
Nov 9th 2017Sergey MinaevFor scientists & Pediatrics & Surgery
Esophageal atresia is malformation which occurs 1 per 3000 to 1 per 5000 births. There is no uniform consensus in treatment of complex long-gap esophageal atresia (CLGEA). The controversy is mostly based on severity and variety of complications of the anastomosis.
In the scientific work authors [1] perform an anastomosis of the native esophagus after patient-adapted elongation therapy avoiding gastric pull-up and colonic interposition. Five children with CLGEA (≥5 vertebral bodies gap) were referred to our department in 2016. All patients had been operated on previously at outside facilities. All children were admitted to our department with esophagostomy and gastrostomy after having anastomotic insufficiency and/or esophageal (in two cases) or colonic interponate necrosis (in one case). As one of our major goals is to perform an anastomosis of the native esophagus, we used a Foker-technique using traction sutures to lengthen the esophageal pouches within days and multistaged extrathoracic esophageal elongation described by Kimura, to solve the long gap problem and make a primary repair possible.
Anastomotic stricture is the most common complication following operative repair. Balloon dilatation was necessary in 4 cases; each of these patients was dilated 3–5 times. Postanastomotic weight gain at 4-month mean follow-up was an average 19±4 g/day. Two patients had recurrent laryngeal nerve palsy, of which one has recovered in follow-up interval. Two children developed gastroesophageal reflux in 2-month follow-up after anastomosis. Nevertheless the prevalence of gastroesophageal reflux after replacement of the esophagus is much higher as well as
anastomotic leak, stricture and respiratory problems.
In the scientific work [2] showed cases with insuperable diastasis between segments of the esophagus are the most complex. Induction of esophageal growth by its extension proposed by Focker is one of the most popular methods of solving this problem. The clinical case of treatment of the child with multiple malformations, including an esophagus atresia with insuperable to diastases is given in article.
Multistage esophageal elongation using combined Kimura and Foker techniques is a challenging undertaking that requires a series of surgical interventions. However, anastomosis of the native esophagus can be achieved. Pros and cons must therefore be carefully weighed.
References:
- Sterlin A., Ötzmann von Sochaczewski Ch., Fotache G., Engel V., Gödeke J., Muensterer O. Our experience of secondary multistage treatment for complex long gap esophageal atresia. Medical News of North Caucasus. 2017:12(3):279-281. doi: 10.14300/mnnc.2017.12085
- Aksel’rov M. A., Emel’janova V. A., Minaev S. V., Suprunec S. N., Sergienko T. V., Karlova M. N., Kiseleva N. V., Stoljar A. V. Successful application toracoskopy (elongation by focker and formation deferred anastomosis) in a child with multiple malformations, including esophageal atresia with irresistible diastase. Medical News of North Caucasus. 2017:12(2):138-141. doi: 10.14300/mnnc.2017.12039
