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La tracción interna como un puente eficaz para una anastomosis exitosa en la atresia esofágica compleja
Sarthak Tandon1, Jo-Anne Brooks2, Ruth K Armstrong3
1Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia.
Journal of pediatric surgery
|August 20, 2025
Resumen
Las suturas de tracción interna ofrecen una estrategia de manejo primario eficaz para casos complejos de atresia esofágica (EA), logrando altas tasas de anastomosis primaria retrasada exitosa y potencialmente autoanastomosis esofágica.
Área de la Ciencia:
- Cirugía pediátrica
- Cirugía torácica
- Gastroenterología
Sus antecedentes:
- La tracción interna es una técnica emergente para el manejo de la atresia esofágica de larga distancia (LGEA) y la atresia esofágica (EA) con fístula traqueoesofágica distal cuando la anastomosis primaria no es factible.
- Este estudio evalúa los resultados y las complicaciones asociadas con las suturas de tracción interna en pacientes con EA.
Objetivo del estudio:
- Evaluar la eficacia de las suturas de tracción interna como estrategia de gestión primaria en EA compleja.
- Para determinar las tasas de éxito de la anastomosis esofágica y las complicaciones asociadas.
Principales métodos:
- Una revisión retrospectiva de 23 pacientes consecutivos con EA que se sometieron a una sutura de tracción interna entre 2014 y 2025.
- Datos recopilados de una base de datos de EA institucional y gráficos médicos, centrados en la anastomosis exitosa, las complicaciones relacionadas con la tracción y a largo plazo.
- Pruebas de nivel IV basadas en series de casos retrospectivas.
Principales resultados:
- Dieciocho pacientes (78,3%) lograron una anastomosis primaria retrasada con éxito; 4 (21,1%) tuvieron una autoanastomosis esofágica.
- Se produjeron complicaciones relacionadas con la tracción en 3 pacientes (13,0%), incluidas fugas esofágicas y de aire; 3 pacientes requirieron volver a tensar las suturas.
- Se desarrollaron estenosis anastomótica en 12 pacientes (57,1%) durante una mediana de seguimiento de 3,7 años; no se requirió fundoplicación ni reemplazo esofágico.
Conclusiones:
- La tracción interna es una estrategia de manejo primario eficaz para EA complejo, que produce altas tasas de anastomosis primaria retrasada exitosa.
- La tracción interna también puede conducir con poca frecuencia a la autoanastomosis esofágica.
- Este enfoque es prometedor para la gestión de casos difíciles de EA sin necesidad inmediata de procedimientos más invasivos.
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