Borselle, D;
Davidson, J;
Loukogeorgakis, S;
De Coppi, P;
Patkowski, D;
(2024)
Thoracoscopic Stage Internal Traction Repair Reduces Time to Achieve Oesophageal Continuity in Long Gap Oesophageal Atresia.
European Journal of Pediatric Surgery
Access restricted to UCL open access staff until 29 December 2024. |
Abstract
Aim of the study: Management of long gap oesophageal atresia (LGOA) is controversial. This study aims at comparing the management of LGOA between two high-volume centers. Methods: We included patients with LGOA (type A and B) between 2008 and 2022. Demographics, surgical methods and outcomes were collected and compared. Results: The study population involved 28 patients-Centre A and 24 patients-Centre B. A surgical approach was thoracoscopic in the Centre A, only for one patient was open for final procedure. In the Centre B 3 patients were treated only thoracoscopically, 2 converted to open and 19 as open surgery. In the Centre A primary oesophageal anastomosis concerned 1 case, two-staged oesophageal lengthening using external traction-1 patient and 26 were treated with the multi-staged internal traction technique. In 24 patients a full anastomosis was achieved: in 23 patients the internal traction technique solely was used, and 1 patient required open Collis-Nissen procedure as final management. In the Centre B primary anastomosis was performed in 7 patients, delayed oesophageal anastomosis in 8 patients, oesophageal lengthening using external traction in one case and 9 infants required oesophageal replacement with gastric tube. Analysed postoperative complications included: early mortality-2/28 due to accompanied malformations (Centre A) and 0/24 (Centre B); anastomotic leakage-4/26 (Centre A) treated conservatively-all patients had a contrast study and 0/24 (Centre B)-1 case of pleural effusion, but no routine contrast study); recurrent strictures 13/26 (Centre A) and 7/15 (Centre B); need for fundoplication 5/26 (Centre A) and 2/15(Centre B). Age at oesophageal continuity was as a median 31 days in Centre A and 110 days in Centre B. Median time between initial procedure and the oesophageal anastomosis was 11 days in Centre A and 92 days in Centre B Conclusions: Thoracoscopic internal traction technique reduces time to achieve oesophageal continuity and the need for oesophageal substitution while maintaining a similar early complication rate.
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#Thoracoscopic #Stage #Internal #Traction #Repair #Reduces #Time #Achieve #Oesophageal #Continuity #Long #Gap #Oesophageal #Atresia
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