Augusto Zani1, Giovanni Cobellis1, Justyna Wolinska1, Priscilla P L Chiu1, Agostino Pierro2,3. 1. Division of General and Thoracic Surgery, Physiology and Experimental Medicine Program, The Hospital for Sick Children, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada. 2. Division of General and Thoracic Surgery, Physiology and Experimental Medicine Program, The Hospital for Sick Children, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada. agostino.pierro@sickkids.ca. 3. University of Toronto, Toronto, Canada. agostino.pierro@sickkids.ca.
Abstract
PURPOSE: To evaluate long-term outcomes of pure esophageal atresia (EA) repair with preservation of native esophagus. METHODS: Infants with pure EA treated at our institution (2000-2010) and with minimum 5-year follow-up were reviewed (REB:1000046653). Data analysed included demographics, management and outcomes and are reported as mean ± SD/median (range). RESULTS: Of 185 infants with EA, 12 (7 %) had pure EA (gestational age: 36 ± 2.4 weeks, birth weight: 2353 ± 675 g). Ten had associated anomalies, including trisomy-21 (n = 2) and duodenal atresia (n = 1). SURGERY: 1 patient (short gap) underwent primary thoracoscopic anastomosis, 11 had gastrostomy (Stamm, n = 5; image-guided, n = 6) as initial procedure. At definitive repair (age: 128 ± 91 days; weight 5.5 ± 2.3 kg): ten had primary anastomosis and 1 had Collis gastroplasty. No patient had esophageal replacement surgery. OUTCOMES: three patients had gastrostomy dehiscence requiring re-operation. At post-operative esophagram, seven had anastomotic leak successfully treated conservatively. Seven patients developed strictures requiring balloon dilatations (median two dilatations, range 1-10), six received antireflux surgery. At 7-year follow-up (range 5-15 years), all patients had the gastrostomy closed and were on full oral feeds. CONCLUSIONS: The management of pure EA continues to be challenging. The preservation of native esophagus is possible with significant morbidity. The long-term outcomes are favourable.
PURPOSE: To evaluate long-term outcomes of pure esophageal atresia (EA) repair with preservation of native esophagus. METHODS:Infants with pure EA treated at our institution (2000-2010) and with minimum 5-year follow-up were reviewed (REB:1000046653). Data analysed included demographics, management and outcomes and are reported as mean ± SD/median (range). RESULTS: Of 185 infants with EA, 12 (7 %) had pure EA (gestational age: 36 ± 2.4 weeks, birth weight: 2353 ± 675 g). Ten had associated anomalies, including trisomy-21 (n = 2) and duodenal atresia (n = 1). SURGERY: 1 patient (short gap) underwent primary thoracoscopic anastomosis, 11 had gastrostomy (Stamm, n = 5; image-guided, n = 6) as initial procedure. At definitive repair (age: 128 ± 91 days; weight 5.5 ± 2.3 kg): ten had primary anastomosis and 1 had Collis gastroplasty. No patient had esophageal replacement surgery. OUTCOMES: three patients had gastrostomy dehiscence requiring re-operation. At post-operative esophagram, seven had anastomotic leak successfully treated conservatively. Seven patients developed strictures requiring balloon dilatations (median two dilatations, range 1-10), six received antireflux surgery. At 7-year follow-up (range 5-15 years), all patients had the gastrostomy closed and were on full oral feeds. CONCLUSIONS: The management of pure EA continues to be challenging. The preservation of native esophagus is possible with significant morbidity. The long-term outcomes are favourable.
Authors: Augusto Zani; Simon Eaton; Michael E Hoellwarth; Prem Puri; Juan Tovar; Guenter Fasching; Pietro Bagolan; Marija Lukac; Rene Wijnen; Joachim F Kuebler; Giovanni Cecchetto; Risto Rintala; Agostino Pierro Journal: Eur J Pediatr Surg Date: 2013-08-09 Impact factor: 2.191
Authors: Shaun M Kunisaki; Steven W Bruch; Ronald B Hirschl; George B Mychaliska; Marjorie C Treadwell; Arnold G Coran Journal: Pediatr Surg Int Date: 2014-07-24 Impact factor: 1.827
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