Augusto Zani1, Simon Eaton1, Michael E Hoellwarth2, Prem Puri3, Juan Tovar4, Guenter Fasching5, Pietro Bagolan6, Marija Lukac7, Rene Wijnen8, Joachim F Kuebler9, Giovanni Cecchetto10, Risto Rintala11, Agostino Pierro1. 1. Department of Pediatric Surgery, University College London Institute of Child Health, London, United Kingdom. 2. Department of Pediatric and Adolescents Surgery, Medical University of Graz, Graz, Austria. 3. Department of Pediatric Surgery, National Children's Research Centre, Dublin, Ireland. 4. Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain. 5. Department of Pediatric Surgery, Klagenfurt General Hospital, Klagenfurt, Austria. 6. Neonatal Surgery Unit, Bambino Gesù Children's Research Hospital, Rome, Italy. 7. Department of Pediatric Surgery, Faculty of Medicine, University Children's Hospital, Belgrade, Serbia. 8. Department of Pediatric Surgery, Erasmus MC, Sophia in Erasmus MC Sophia Childrens' Hospital, Rotterdam, The Netherlands. 9. Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany. 10. Department of Pediatric Surgery, University Hospital of Padua, Padova, Italy. 11. Department of Pediatric Surgery, Hospital for Children and Adolescents, Helsinki, Finland.
Abstract
INTRODUCTION: Because many aspects of the management of esophageal atresia (EA) are still controversial, we evaluated the practice patterns of this condition across Europe. METHODS: A survey was completed by 178 delegates (from 45 [27 European] countries; 88% senior respondents) at the EUPSA-BAPS 2012. RESULTS: Approximately 66% of respondents work in centers where more than five EA repairs are performed per year. Preoperatively, 81% of respondents request an echocardiogram, and only 43% of respondents routinely perform preoperative bronchoscopy. Approximately 94% of respondents prefer an open approach, which is extrapleural in 71% of respondents. There were no differences in use of thoracoscopy between Europeans (10%) and non-Europeans (11%, p = nonsignificant). Approximately 60% of respondents measure the gap intraoperatively. A transanastomotic tube (90%) and chest drain (69%) are left in situ. Elective paralysis is adopted by 56% of respondents mainly for anastomosis tension (65%). About 72% of respondents routinely request a contrast study on postoperative day 7 (2-14). Approximately 54% of respondents use parenteral nutrition, 40% of respondents start transanastomotic feeds on postoperative day 1, and 89% of respondents start oral feeds after postoperative day 5. Pure EA: 46% of respondents work in centers that repair two or more than two pure EA a year. About 60% of respondents opt for delayed primary anastomosis at 3 months (1-12 months) with gastrostomy formation without esophagostomy. Anastomosis is achieved with open approach by 85% of respondents. About 47% of respondents attempt elongation of esophageal ends via Foker technique (43%) or with serial dilations with bougies (41%). Approximately 67% of respondents always attempt an anastomosis. Gastric interposition is the commonest esophageal substitution. CONCLUSION: Many aspects of EA management are lacking consensus. Minimally invasive repair is still sporadic. We recommend establishment of an EA registry. Georg Thieme Verlag KG Stuttgart · New York.
INTRODUCTION: Because many aspects of the management of esophageal atresia (EA) are still controversial, we evaluated the practice patterns of this condition across Europe. METHODS: A survey was completed by 178 delegates (from 45 [27 European] countries; 88% senior respondents) at the EUPSA-BAPS 2012. RESULTS: Approximately 66% of respondents work in centers where more than five EA repairs are performed per year. Preoperatively, 81% of respondents request an echocardiogram, and only 43% of respondents routinely perform preoperative bronchoscopy. Approximately 94% of respondents prefer an open approach, which is extrapleural in 71% of respondents. There were no differences in use of thoracoscopy between Europeans (10%) and non-Europeans (11%, p = nonsignificant). Approximately 60% of respondents measure the gap intraoperatively. A transanastomotic tube (90%) and chest drain (69%) are left in situ. Elective paralysis is adopted by 56% of respondents mainly for anastomosis tension (65%). About 72% of respondents routinely request a contrast study on postoperative day 7 (2-14). Approximately 54% of respondents use parenteral nutrition, 40% of respondents start transanastomotic feeds on postoperative day 1, and 89% of respondents start oral feeds after postoperative day 5. Pure EA: 46% of respondents work in centers that repair two or more than two pure EA a year. About 60% of respondents opt for delayed primary anastomosis at 3 months (1-12 months) with gastrostomy formation without esophagostomy. Anastomosis is achieved with open approach by 85% of respondents. About 47% of respondents attempt elongation of esophageal ends via Foker technique (43%) or with serial dilations with bougies (41%). Approximately 67% of respondents always attempt an anastomosis. Gastric interposition is the commonest esophageal substitution. CONCLUSION: Many aspects of EA management are lacking consensus. Minimally invasive repair is still sporadic. We recommend establishment of an EA registry. Georg Thieme Verlag KG Stuttgart · New York.
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