新生児におけるロングギャップ食道閉鎖症に対する腹腔鏡下胃瘻造設術

The conventional management of long gap oesophageal atresia (LGOA) typically involves the insertion of a gastrostomy shortly after birth. This is our experience with laparoscopic gastrostomy tube (LGt) insertion in newborns diagnosed with LGOA.

A retrospective review of medical records for cases of LGOA that underwent laparoscopic-assisted Seldinger gastrostomy placement between 2019 and 2024. A 5 mm camera and 3 mm instruments were used to place transabdominal sutures to the stomach, which was then punctured with a needle and insufflated with 2 ml of air. A Seldinger wire and dilators were then used to insert a balloon gastrostomy tube. The sutures were tied extra-corporeally.

Eight newborns with LGOA underwent LGt (median gestation 36.5 weeks, age 2 days, birth weight 2.2 kg. Seven neonates were fitted with a 12Fr gastrostomy tube, while one premature infant (33-week gestation, 1.4 kg) had an 8Fr Foley catheter. A contrast study was performed the following day to confirm the correct position of the feeding tube, and feeding was initiated after 24 h. There were no immediate complications or instances of tube displacement observed. Ultimately, all patients successfully underwent staged thoracoscopic repair of their LGOA using external traction sutures.

The insertion of LGt proved to be safe, in our series despite the tiny size of their stomachs. This minimally invasive approach offers several advantages, including excellent visualization, reduced liver retraction, and less manipulation of the stomach. Additionally, it may lead to fewer adhesions, which is an important factor to consider since many patients with LGOA will require fundoplication in the future.