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What Proportion of Children With Complex Oesophageal Atresia Require Oesophageal Lengthening Procedures?

Laura Phillips1, Bruce Jaffray1

  • 1The Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne, United Kingdom.

Journal of Pediatric Surgery
|November 15, 2023
PubMed

Insights

Management of complex esophageal atresia (OA) without lengthening procedures maintains the native esophagus with less morbidity. This study suggests lengthening is rarely needed for complex OA cases.

Area of Science:

  • Pediatric Surgery
  • Thoracic Surgery
  • Congenital Anomalies

Background:

  • Complex esophageal atresia (OA) cases often require surgical intervention beyond primary anastomosis.
  • Oesophageal lengthening techniques have been employed for complex OA, but outcomes require further evaluation.

Purpose of the Study:

  • To compare the outcomes of managing complex OA with and without oesophageal lengthening procedures.
  • To assess the rate of native oesophagus retention and associated morbidities.

Main Methods:

  • A consecutive series of complex OA patients treated in a regional center was analyzed.
  • Outcomes including native oesophagus retention, complications (thoracotomy, anastomotic leak, stricture), and mortality were recorded.
  • Surgical techniques, specifically oesophageal lengthening versus non-lengthening approaches, were examined as explanatory variables.

Main Results:

  • Of 215 OA cases, 29 (13%) were complex; 25 survived to repair.
  • The native oesophagus was retained in 97% of all OA cases without lengthening.
  • Among complex OA cases not treated with lengthening, 78% retained their native oesophagus with significantly less morbidity compared to lengthening procedures.

Conclusions:

  • Managing complex OA without oesophageal lengthening yields similar native oesophagus retention rates as lengthening techniques.
  • Non-lengthening management of complex OA is associated with significantly reduced morbidity.
  • Oesophageal lengthening procedures appear to have limited applicability in the current management of complex OA.
Abstract

Keywords:
Complex oesophageal atresiaLong gapOesophageal atresiaOesophageal lengtheningOesophageal replacement

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