scholarly journals Usefulness of Gastrojejunostomy Prior to Fundoplication in Severe Gastro-Esophageal Reflux Complicating Long-Gap Esophageal Atresia Repair: A Preliminary Study

Children ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. 55
Author(s):  
Francesca Destro ◽  
Luciano Maestri ◽  
Milena Meroni ◽  
Federico Rebosio ◽  
Giulia Del Re ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Hospital Admissions ◽  
Growth Failure ◽  
Esophageal Reflux ◽  
Long Gap ◽  
Nutritional Conditions ◽  
Significant Difference ◽  
Significant Amelioration ◽  
Long Gap Esophageal Atresia

Background: Gastro-esophageal reflux disease (GERD), requiring surgical correction, and nutritional problems are reported after long-gap esophageal atresia (LGEA) repair and might jeopardize the postoperative course in some babies. We report an exploratory evaluation of the role of transgastric jejunostomy (TGJ) as a temporary nutritional tool before surgery for GERD in LGEA. Methods: Seven infant patients operated on for LGEA with intra-thoracic gastro-esophageal junction (GEJ) and growth failure, requiring improvement in their nutritional profile in anticipation of surgery, were retrospectively evaluated. Post-surgical follow-up, including growth evolution, complications, and parental quality of life (QoL), were considered. Results: The TGJ was placed at a mean age of 8.6 ± 5.6 months. The procedure was uneventful and well-tolerated in all seven cases. At 6.6 ± 2.0 months after TGJ placement, significant weight gain (weight z-score −2.68 ± 0.8 vs −0.9 ± 0.2, p < 0.001) was recorded, allowing the GERD surgery to proceed. A significant difference in hospital admissions between 3 months before and post-TGJ insertion was noted (4.8 ± 0.75 vs. 1.6 ± 0.52, p < 0.01). A significant amelioration of QoL after TGJ placement was also recorded; in particular, the biggest improvements were related to parents’ perceptions of the general health and emotional state of their babies (p < 0.001). Conclusions: The placement of TGJ as a temporary nutritional tool in selected cases of LGEA could improve nutritional conditions and parental QoL before fundoplication, allowing successful surgical treatment of GERD to be carried out.

DOZ047.19: Outcomes in the management of long-gap esophageal atresia: is the Foker technique superior?

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
A Wiseman ◽  
J Krishnan ◽  
D Wanaguru ◽  
C Langusch ◽  
V Varjavandi ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Type A ◽  
Small Sample ◽  
Type B ◽  
Repair Technique ◽  
Long Gap ◽  
Delayed Repair ◽  
Significant Difference ◽  
Long Gap Esophageal Atresia ◽  
Type C

Abstract Background Long-gap esophageal atresia (LGEA) has traditionally been managed by delayed anastamosis. However, over the last 10 years the Foker technique of esophageal growth elongation has been used. There is limited data evaluating outcomes using both techniques. Aims The aim of this study was to compare the outcomes in LGEA repair using the traditional delayed repair technique versus the Foker technique. Methods A retrospective chart review was done of LGEA patients at Sydney Children's Hospital between 1997 and 2016, comparing the Foker technique with the delayed repair technique. Results There were 9 children repaired using the Foker technique, and 10 by delayed repair. There were 7 patients with Type A, 1 with Type B, and 1 with Type C in the Foker group and in the delayed repair cohort, 5 were Type A, 2 Type B, 2 Type C, and 1 Type D esophageal atresia/tracheoesophageal fistula. There were 4 males in the Foker group and 5 in the non-Foker group. Median time to join was 59 days (15–117 days) for Foker repair and 173 days (16–433 days) for delayed repair. There was no significant difference in the incidence of post-operative leak, incidence of strictures needing dilation, presence of reflux symptoms, presence of reflux esophagitis on endoscopy, proton pump inhibitor use, need for fundoplication, incidence of cyanotic spells, occurrence of recurrent fistula, and symptoms of dysphagia when comparing both groups. Data on time to oral feeds and incidence of malnutrition was incomplete. Details are shown in Table 1. Conclusions Although the time to anastamosis was shorter in the Foker group and the incidence of post-operative leak, strictures needing dilation, need for fundoplication, and dysphagia were lower in the Foker group, the difference was not significant probably secondary to the small sample size. These results require validation in larger cohorts.

PS01.092: FOKER GROWTH INDUCTION FOR LONG GAP ESOPHAGEAL ATRESIA: WHAT WE HAVE LEARNED

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 75-76
Author(s):  
Wendy Jo Svetanoff ◽  
Sigrid Bairdain ◽  
David Zurakowski ◽  
Thomas Hamilton ◽  
Susannah Clark ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Hospital Admissions ◽  
Conflicts Of Interest ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
Long Gap ◽  
Icu Length Of Stay ◽  
Hospital Stays ◽  
Long Gap Esophageal Atresia ◽  
Late Group

Abstract Background The Foker process is used in patients with long-gap esophageal atresia (LGEA) to maintain the native esophagus; however, chemical paralysis, used to ‘protect’ the esophagus, is associated with complications and longer hospital stays. The purpose of this study was to identify changes in practice patterns with increased Foker experience, and to review the relationship of paralysis time with the incidence of esophageal leaks and need for stricture resections. Methods A retrospective review of LGEA patients from January 2006 to December 2016 was performed. Patients were excluded if they had previous attempts elsewhere. Patients were initially divided into two groups: early group (surgery before 2013) and late group (2013–2016) to assess outcomes. All patients, irrespective of surgery date, were then divided into three subgroups based on esophageal anastomotic tension. Logistic regression with odds ratio (OR) and 95% confidence interval (CI) was used to assess risk of leaks and need for stricture resection. Results Fifty-eight patients met criteria, and demographics were similar between groups. The late group required significantly fewer surgeries between Foker I and Foker II and had shorter ICU length of stay (LOS). Variables that trended towards statistical significance included total length of paralysis, time between Foker I and Foker II, and total hospital LOS. Overall, 18 patients developed a leak, and 13 required stricture resections. There was no correlation between paralysis time or anastomotic tension with incidence of leak or stricture resection. Multivariable analysis indicated that the occurrence of a leak (OR 5.7, 95% CI: 1.4–27.3, P = 0.025) and need for > 8 dilations (OR 11.0, 95% CI: 2.3–53.4, P = 0.002) were significant predictors of need for stricture resection. Conclusion As our experience has grown, the need for multiple procedures between Foker I and Foker II has decreased, leading to less paralytic exposure, shorter ICU LOS, and trending toward decreased hospital LOS. By verifying that specified paralysis times are not required, we can continue to mitigate complications associated with lengthy paralysis times and longer hospital admissions without risking esophageal health. Disclosure All authors have declared no conflicts of interest.

O-04 (16:41 to 16:53): The Role of Major Flap in Case of Long Gap Esophageal Atresia

2016 ◽  
Vol 29 (3) ◽  
pp. 286-286
Author(s):  
L. Valfre ◽  
A. Conforti ◽  
B.D. Iacobelli ◽  
F. Fusaro ◽  
F. Morini ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Long Gap ◽  
Long Gap Esophageal Atresia

DOZ047.124: Thoracoscopic anatomy of long-gap esophageal atresia. What can we predict?

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
M Rasiewicz ◽  
K Świątek ◽  
S Gerus ◽  
D Patkowski
Keyword(s):  
Esophageal Atresia ◽  
Gold Standard ◽  
Distal Stump ◽  
Thoracic Vertebrae ◽  
Long Gap ◽  
Thoracoscopic Repair ◽  
Proximal Stump ◽  
Long Gap Esophageal Atresia ◽  
Vertebral Bodies ◽  
Traction Group

Abstract Since the very beginning in 1999, thoracoscopic repair of esophageal atresia has become a gold standard in many pediatric surgery centers worldwide. Despite the advances in surgical technique, treatment of long-gap esophageal atresia still remains a challenge. The aim of this study is to assess whether the localization of esophageal stumps can predict number of stages needed to perform anastomosis. We analyzed video records of 21 patients who underwent staged thoracoscopic repair of long-gap esophageal atresia using internal traction technique. All procedures were performed by the same surgeon. We divided patients into two groups: first requiring single internal traction procedure, second who underwent multiple procedures. We assessed esophageal stump position in relation to thoracic vertebrae. The distance between stumps was measured in vertebral bodies. Mean distance between esophageal ends was 5.8 in single traction group. The distance between the stumps was significantly greater in multiple procedures group: 7.33 (P = 0.003). Patients who required multiple procedures had significantly lower localization of distal stump. Localization of proximal stump did not affect the possibility for anastomosis after single traction. Distance between both ends after internal traction was also significantly longer in multiple procedures group. Patients with lower localization of distal esophageal stump assessed during primary thoracoscopy are at higher risk for requiring multiple surgical procedures.

DOZ047.36: Thoracoscopic esophageal internal axial traction for long- gap esophageal atresia

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
M Juricic ◽  
N Panait ◽  
G Podevin ◽  
A Bonnard ◽  
P Lopez ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Operative Time ◽  
Median Number ◽  
Ethical Review ◽  
Multicenter Observational Study ◽  
Long Gap ◽  
Esophageal Anastomosis ◽  
Long Gap Esophageal Atresia ◽  
Axial Traction ◽  
Median Operative Time

Abstract Aim of the Study Long-gap esophageal atresia (LGEA) remains a surgical challenge. This study aimed to report the results of thoracoscopic esophageal axial internal traction in LGEA. Methods This multicenter observational study included retrospectively neonates who underwent primary thoracoscopic esophageal axial internal traction for LGEA between June 2017 and July 2018. LGEA was defined as the technical impossibility to perform a primary esophageal anastomosis. The Ethical Review Board of our institution approved the study. Main Results Eight neonates were included with a median gestational age at birth of 35 weeks [25; 37] and a median birth weight of 2266 g [890; 3800], 6 types I and 2 types II according to Ladd's classification. Initial median gap between 2 esophageal ends was 5 vertebral bodies [4.5; 7]. Internal traction was performed at a median age of 5 weeks of life [1; 17] with a median operative time of 87 minutes. Four patients required at least 2 internal traction procedures. After a mean traction time of 1.5 weeks [1; 13.5], esophageal anastomosis was successfully performed in 7 patients (5 thoracoscopies, 2 thoracotomies) with a median operative time of 165 minutes. One patient needed a colonic interposition. Five of these 7 patients required an esophageal endoscopic dilatation (median number: 4 [2; 6]). Median follow-up was 9.75 months [3; 16]. Conclusions Thoracoscopic esophageal axial internal traction for LGEA was a safe and feasible procedure that allowed an esophageal anastomosis in 7 of the 8 patients. Improvement of the procedure requires setting a common protocol concerning the timing of the first internal axial traction and the duration of traction before considering esophageal anastomosis.

Short-interval staged thoracoscopic surgery for long-gap esophageal atresia

2019 ◽  
Vol 1 (1) ◽  
pp. 37-40
Author(s):  
Juan C. de Agustín-Asensio ◽  
Beatriz Fernández-Bautista ◽  
María Antonia García-Casillas
Keyword(s):  
Esophageal Atresia ◽  
Thoracoscopic Surgery ◽  
Short Interval ◽  
Long Gap ◽  
Long Gap Esophageal Atresia
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