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Updated: Jun 1, 2025
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Experience in the treatment of type C congenital esophageal atresia using a staged approach
Yong Zhao1, Shihui Tan1, An Wang1
1Department of Neonatal Surgery, National Center for Children's Health, Beijing Children Hospital, Capital Medical University, 56 Nanlishi Road, Beijing, 100045, China.
Insights
For type C esophageal atresia (EA) not suitable for primary repair, a staged approach is necessary. This study highlights a staged management strategy for type C EA, emphasizing simpler initial operations and effective delayed anastomosis techniques.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Gastroenterology
Background:
- Type C esophageal atresia (EA) often necessitates a staged surgical approach when primary anastomosis is not feasible.
- Management strategies for type C EA require careful consideration to optimize outcomes.
Purpose of the Study:
- To summarize the experience and outcomes of managing type C EA using a staged approach.
- To evaluate the effectiveness of different surgical techniques in a staged repair protocol.
Main Methods:
- Retrospective chart review of patients with type C EA not amenable to primary anastomosis.
- Data collection on clinical information and follow-up outcomes.
- Analysis of initial surgical procedures and subsequent delayed anastomosis.
Main Results:
- Seven patients with type C EA underwent staged repair, with initial surgeries including thoracotomy and thoracoscopy.
- Complications after initial surgery were frequent (71%), including pyopneumothorax, pneumonia, recurrent tracheoesophageal fistula (rTEF), and anastomotic leak.
- Delayed anastomosis, mostly thoracoscopic, showed complications such as recurrent esophageal pulmonary fistula (rEPF) in 50%, anastomotic leak in 33%, and esophageal stricture in all patients.
Conclusions:
- Initial operations for type C EA should be simple and minimal.
- Internal traction is an effective method for facilitating subsequent anastomosis.
- Intraoperative indocyanine green fluorescence can assist in fistula identification and anastomosis.
Background:
In select patients with type C esophageal atresia, primary anastomosis is not appropriate and a staged approach is required. We aim to summarize our experience in the management of type C EA using a staged approach.
Methods:
A retrospective chart-review of patients with type C EA admitted to Beijing Children's Hospital between July 2020 to October 2023 were conducted. Those diagnosed with type C EA who were not amendable to primary anastomosis were included for analysis. Clinical information was recorded, and follow- up was performed.
Results:
Seven (five boys) patients with type C EA who received staged repair were included in the study. Initial surgeries included thoracotomy and thoracoscopy. 71% (5/7) patient had complications after the initial surgery, including pyopneumothorax, pneumonia, recurrent tracheoesophageal fistula (rTEF), and anastomotic leak. Esophageal elongation techniques were applied in 3 patients. All delayed anastomosis were performed thoracoscopically, except for in one case where spontaneous fistulization occurred and no anastomosis were necessary. Complications after delayed anastomosis included recurrent esophageal pulmonary fistula (rEPF) in 50% (3/6), anastomotic leak in 33% (2/6), and esophageal stricture in all (6/6) patients. After a median follow-up of 14 months (range: 2-24), all patients were in generally good condition.
Conclusion:
Primary operations should be kept simple and minimal in patients diagnosed with type C EA who are not appropriate for primary anastomosis. Internal traction is an effective method that allows for subsequent anastomosis. Intraoperative indocyanine green fluorescence can aid in fistula determination and anastomosis.
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