Sigrid Bairdain1, Thomas E Hamilton1, Charles Jason Smithers1, Michael Manfredi2, Peter Ngo2, Dorothy Gallagher1, David Zurakowski3, John E Foker4, Russell W Jennings5. 1. Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA. 2. Division of Gastroenterology & Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA. 3. Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, Boston, MA. 4. University of Minnesota, Minneapolis, MA. 5. Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA. Electronic address: Russell.jennings@childrens.harvard.edu.
Abstract
PURPOSE: The Foker process (FP) uses tension-induced growth for primary esophageal reconstruction in patients with long gap esophageal atresia (LGEA). It has been less well described in LGEA patients who have undergone prior esophageal reconstruction attempts. METHODS: All cases of LGEA treated at our institution from January 2005 to April 2014 were retrospectively reviewed. Patients who initially had esophageal surgery elsewhere were considered secondary FP cases. Demographics, esophageal evaluations, and complications were collected. Median time to esophageal anastomosis and full oral nutrition was estimated using the Kaplan-Meier method. Multivariate Cox-proportional hazards regression identified potential risk factors. RESULTS: Fifty-two patients were identified, including 27 primary versus 25 secondary FP patients. Median time to anastomosis was 14 days for primary and 35 days for secondary cases (p<0.001). Secondary cases (p=0.013) and number of thoracotomies (p<0.001) were identified as significant predictors for achieving anastomosis and the development of a leak. Predictors of progression to full oral feeding were primary FP cases (O.R.=17.0, 95% CI: 2.8-102, p<0.001) and patients with longer follow-up (O.R.=1.06/month, 95% CI: 1.01-1.11, p=0.005). CONCLUSIONS: The FP has been successful in repairing infants with primary LGEA, but the secondary LGEA patients proved to be more challenging to achieve a primary esophageal anastomosis. Early referral to a multidisciplinary esophageal center and a flexible approach to establish continuity in secondary patients is recommended. Given their complexity, larger studies are needed to evaluate long-term outcomes and discern optimal strategies for reconstruction.
PURPOSE: The Foker process (FP) uses tension-induced growth for primary esophageal reconstruction in patients with long gap esophageal atresia (LGEA). It has been less well described in LGEA patients who have undergone prior esophageal reconstruction attempts. METHODS: All cases of LGEA treated at our institution from January 2005 to April 2014 were retrospectively reviewed. Patients who initially had esophageal surgery elsewhere were considered secondary FP cases. Demographics, esophageal evaluations, and complications were collected. Median time to esophageal anastomosis and full oral nutrition was estimated using the Kaplan-Meier method. Multivariate Cox-proportional hazards regression identified potential risk factors. RESULTS: Fifty-two patients were identified, including 27 primary versus 25 secondary FP patients. Median time to anastomosis was 14 days for primary and 35 days for secondary cases (p<0.001). Secondary cases (p=0.013) and number of thoracotomies (p<0.001) were identified as significant predictors for achieving anastomosis and the development of a leak. Predictors of progression to full oral feeding were primary FP cases (O.R.=17.0, 95% CI: 2.8-102, p<0.001) and patients with longer follow-up (O.R.=1.06/month, 95% CI: 1.01-1.11, p=0.005). CONCLUSIONS: The FP has been successful in repairing infants with primary LGEA, but the secondary LGEA patients proved to be more challenging to achieve a primary esophageal anastomosis. Early referral to a multidisciplinary esophageal center and a flexible approach to establish continuity in secondary patients is recommended. Given their complexity, larger studies are needed to evaluate long-term outcomes and discern optimal strategies for reconstruction.
Authors: Chandler Rebecca Lee Mongerson; Russell William Jennings; David Zurakowski; Dusica Bajic Journal: Int J Dev Neurosci Date: 2019-09-26 Impact factor: 2.457
Authors: Mackenzie S Kagan; Chandler R L Mongerson; David Zurakowski; Russell W Jennings; Dusica Bajic Journal: Ann Clin Transl Neurol Date: 2021-10-18 Impact factor: 4.511
Authors: Daniel P Kelly; Sigrid Bairdain; David Zurakowski; Brenda Dodson; Kathy M Harney; Russell W Jennings; Cameron C Trenor Journal: Pediatr Surg Int Date: 2016-06-04 Impact factor: 1.827
Authors: Sigrid Bairdain; Brenda Dodson; David Zurakowski; Lawrence Rhein; Brian D Snyder; Melissa Putman; Russell W Jennings Journal: Bone Rep Date: 2015-06-14
Authors: David C van der Zee; Pietro Bagolan; Christophe Faure; Frederic Gottrand; Russell Jennings; Jean-Martin Laberge; Marcela Hernan Martinez Ferro; Benoît Parmentier; Rony Sfeir; Warwick Teague Journal: Front Pediatr Date: 2017-03-31 Impact factor: 3.418
Authors: Chandler R L Mongerson; Sophie L Wilcox; Stacy M Goins; Danielle B Pier; David Zurakowski; Russell W Jennings; Dusica Bajic Journal: Front Pediatr Date: 2019-08-02 Impact factor: 3.418