Long gap esophageal atresia and esophageal replacement: moving toward a separation?

• Published in: Journal of pediatric surgery 2004-07, Vol.39 (7), p.1084-1090
• Main Authors: Bagolan, P, Iacobelli, B.D, De Angelis, P, Federici di Abriola, G, Laviani, R, Trucchi, A, Orzalesi, M, Dall’Oglio, L
• Format: Article
• Language: English
• Subjects: Abnormalities, Multiple - mortality; Abnormalities, Multiple - surgery; Anastomosis, Surgical - adverse effects; Anastomosis, Surgical - methods; Bone and Bones - abnormalities; Cardiovascular Abnormalities - surgery; Cause of Death; Deglutition Disorders - etiology; Esophageal atresia; Esophageal Atresia - mortality; Esophageal Atresia - surgery; esophageal replacement; Esophagitis, Peptic - etiology; Feasibility Studies; Female; Gastrostomy; Humans; Infant, Newborn; long gap; Male; Preoperative Care; Surgical Flaps; Survival Rate; tracheoesophageal fistula; Urogenital Abnormalities - surgery
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2004.03.048

Treatment of long gap esophageal atresia (EA) is still a major challenge. Gastric transposition and colon interposition are the 2 most popular choices for esophageal replacement, but there is general agreement that the child’s own esophagus is the best. The aim of the study was to critically evaluate the feasibility and outcome of primary repair of long gap EA with or without tracheoesophageal fistula (TEF) by direct esophago-esophageal anastomosis as the only technique. Seventy-one neonates with EA+/−TEF were considered. Nineteen cases were classified as long gap (≥3 cm). All infants underwent either primary or shortly delayed repair. In the latter group, a gastrostomy was performed along with an x-ray evaluation of the gap a few days before surgery (mean age, 46.4 days). To avoid disruptive anastomotic force, all infants were kept paralyzed and mechanically ventilated for an additional 6 days after esophageal anastomosis. Before starting feeding, postoperative esophagogram was done on day 7. Endoscopy was done routinely, starting 1 month after surgery; pH monitoring was conventionally performed at 1 year of age or even earlier, should gastroesophageal reflux disease (GERD) be suspected. Follow-up ranged from 11 months to 7 years. In all 19 long gap EA infants an esophago-esophageal anastomosis was performed. Six of them (31%) required an anterior esophageal flap to bridge residual gap. Complications included minor anastomotic leak in 2 cases and anastomotic stricture (