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Is Esophagostomy Necessary in Isolated Esophageal Atresia ? Report of Six Cases. (Abstract)

Aysenur Cerrah Celayir, Osman Zeki Pektas, Alp Gence, Cengiz Gül, Ceyhan Sahin

Department of Pediatric Surgery and, Zeynep Kamil Maternal and Child Diseases Educational and Research Hospital,

Istanbul, Turkiye

 

Abstract

Background: Treatment of long gap esophageal atresia (EA) is still a major challenge. Treatment modalities for delayed repair with or without esophagostomy in isolated esophageal atresia still remains controversial. There is general agreement that the child's own esophagus is the best. The aim of this study is to discuss outcomes of delayed primary esophago-esophageal anastomosis after gastrostomy without esophagostomy in cases with esophageal atresia without a TEF (fistula).

Methods: Results of the treatment of isolated esophageal atresia [Type A] were analyzed retrospectively over a 4 year period. Age at the time of the gastrostomy, gender, associated anomalies, age at the time of the primary repair of the esophagus, [and] outcomes were analyzed using hospital records.

Results: Six neonates with isolated esophageal atresia were analyzed during that period. All cases were classified as long gap (equal or greater than 3 cm). All infants underwent gastrostomy without esophagostomy. Follow-up ranged from 3 months to 44 months. In all cases, esophago-esophageal anastomosis was performed. No ventilatory support was necessary in any patient after the delayed primary esophagus repair. Gastro-esophageal reflux disease occurred in 3 cases, of which, 1 required Thall funduplication. None of the patients had long term esophageal swallowing difficulties nor persistent dysphagia. Two children experienced food aversion. Mean hospital stay was 3 (1 to 6) months. There were 3 deaths: One was due to associated anomalies and two were secondary to late sepsis.

Conclusions: Delayed primary repair of the isolated esophageal atresia without esophagostomy can have a successful outcome providing there is effective continuous aspiration of tthe upper pouch. Gastroesophageal reflux represent the most frequent postoperative problem, but additional procedures required seem "acceptable" to maintain the patient's own esophagus and avoid replacement. Esophageal substitution in long gap esophageal atresia should be reserved only for cases in which there was a previous failed repair.

Key Words: Esophageal atresia, Delayed primary anastomosis, Long gap, Esophageal replacement.

 

 

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