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Respiratory function after esophageal replacement in children
Gabriele Gallo1, Elianne J L E Vrijlandt2, Hubertus G M Arets3
1University Medical Center Groningen, Pediatric Surgery, Groningen, the Netherlands.
Insights
Children undergoing esophageal replacement for long gap esophageal atresia (LGEA) often experience respiratory issues. Gastric pull-up (GPU) may lead to greater lung function impairment than jejunal interposition (JI).
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Respiratory Medicine
Background:
- Esophageal atresia necessitates esophageal anastomosis.
- Long gap esophageal atresia (LGEA) requires esophageal replacement strategies.
- Gastric pull-up (GPU) and jejunal interposition (JI) are common esophageal replacement methods for LGEA.
Purpose of the Study:
- To evaluate long-term respiratory morbidity and lung function in children after esophageal replacement for LGEA.
- To compare respiratory outcomes between GPU and JI procedures.
Main Methods:
- Retrospective cohort study of patients who underwent GPU or JI for LGEA between 1985-2007.
- Data collected via semi-structured interviews and lung function testing (LFT).
Main Results:
- 15 patients (7 GPU, 8 JI) with median age 12 years were included.
- 13/15 patients reported respiratory symptoms; 6/13 showed restriction and 6/13 obstruction on LFT.
- GPU group showed more abnormal lung function (TLC/FEV1/FVC) and restriction compared to the JI group.
Conclusions:
- Many children experience impaired lung function and respiratory symptoms after esophageal replacement for LGEA.
- Gastric pull-up may be associated with greater lung volume reduction compared to jejunal interposition, potentially due to the intrathoracic stomach.
- Lifelong respiratory follow-up is crucial for patients after esophageal replacement.
Background:
Children born with esophageal atresia require an anastomosis between the proximal and distal esophagus. When this distance is too wide (long gap esophageal atresia, LGEA) esophageal replacement strategies have to be deployed. The aim of this study was to assess long-term respiratory morbidity and lung function after esophageal replacement with either stomach (gastric pull-up, GPU) or jejunum (jejunal interposition, JI) for LGEA.
Methods:
Retrospective cohort study. Patients operated with GPU and JI for LGEA (1985-2007) underwent a semi-structured interview and lung function testing (LFT).
Results:
Seven GPU-patients and eight JI-patients were included. Median age was 12years. One patient per group could not perform LFT. Respiratory symptoms were reported by 13/15 patients (7/7 GPU-patients vs 6/8 JI-patients). All LFT items were lower than reference values; 6/13 patients showed restriction and 6/13 obstruction. All six GPU-patients had abnormal TLC and/or FEV1/FVC vs 3/7 after JI. Restriction was noted in 4/6 GPU-patients vs 2/7 JI-patients.
Conclusion:
After esophageal replacement for LGEA many children have impaired lung function and respiratory symptoms are common. Lung volumes seem decreased after GPU compared to JI. This may be caused by the intrathoracic stomach which may limit normal lung growth. Respiratory follow-up in adult life is important after esophageal replacement.
Level Of Evidence:
III.