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Multistaged extrathoracic esophageal elongation procedure for long gap esophageal atresia: Experience with 12
K Kimura1, E Nishijima, C Tsugawa
1Department of Surgery, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
Insights
This study shows multistaged extrathoracic esophageal elongation effectively bridges long gaps in esophageal atresia. This technique allows for gradual esophageal stretching in infants, leading to successful reconstruction.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Congenital Abnormalities
Background:
- Long gap esophageal atresia presents a significant surgical challenge.
- Traditional methods may not adequately bridge extensive esophageal defects.
Purpose of the Study:
- To evaluate the efficacy of a multistaged extrathoracic esophageal elongation procedure.
- To assess its applicability in infants with long gap esophageal atresia.
Main Methods:
- The study involved 12 infants with long gap esophageal atresia (2-7 vertebral body gaps).
- A staged approach involved serial distal translocation of the esophagostomy for gradual elongation.
- Esophageal reconstruction was performed between 5 and 24 months of age.
Main Results:
- The number of elongation stages varied from 1 to 5 per patient.
- All patients tolerated sham feeding, with 3 experiencing minor leakage post-reconstruction.
- All patients developed anastomotic stenosis requiring dilatations, and 11 had gastroesophageal reflux.
Conclusions:
- Multistaged extrathoracic esophageal elongation is an effective method for bridging long esophageal gaps.
- The procedure facilitates necessary esophageal stretching for successful reconstruction in complex cases.
Purpose:
This study evaluates the multistaged extrathoracic esophageal elongation procedure performed on 12 babies with long gap esophageal atresia over 15 years.
Methods:
Eight babies had pure esophageal atresia, 2 had proximal tracheoesophageal fistula (TEF), and 2 had distal TEF. The gaps ranged between 2 and 7 vertebral bodies. Proximal esophagostomy, TEF ligation, and gastrostomy were performed initially. The proximal esophagus is elongated 2 to 3 cm each time by translocating the esophagostomy distally along the anterior chest wall at 2- to 3-month intervals. Sham-fed milk is collected in an ostomy bag and refed via the gastrostomy. The definitive esophageal reconstruction is performed at 5 to 24 months of age.
Results:
Only one elongation was required in 4 babies, 2 were needed in 5, 3 in 2, and 5 in 1 patient. All patients tolerated sham feeding well. After esophageal restoration, 3 patients had minor leakage. All (12 of 12) patients had anastomotic stenosis requiring multiple dilatations, of which, 3 needed resection of stricture. Eleven patients had gastroesophageal reflux that required fundoplication. Follow-up was possible in 11 patients for 4 months to 14 years after esophageal restoration. Seven early patients are eating normally.
Conclusion:
Multistaged extrathoracic esophageal elongation is effective in stretching the proximal esophagus to bridge 2 to 7 vertebral bodies.
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