Ann Surg Treat Res.  2014 Feb;86(2):83-90. 10.4174/astr.2014.86.2.83.

Comparison of outcomes according to the operation for type A esophageal atresia

• Huh YJ
• Kim HY
• Lee SC
• Park KW
• Jung SE

• KMID: 1908502
• DOI: http://doi.org/10.4174/astr.2014.86.2.83

Abstract

PURPOSE
The purpose was to evaluate outcomes according to different operative strategies of type A esophageal atresia (EA).
METHODS
All patients who underwent surgery for type A EA between 1980 and 2011 were included. Patients were divided into 2 groups: E-E group included patients who received esophageal end-to-end anastomosis, whereas E-G group included patients who received esophago-gastric tube anastomosis.
RESULTS
Twenty-two patients were included. The median gestational age was 37.5 weeks. The median birth weight was 2.5 kg. Twenty-one patients underwent gastrostomy as initial procedures, and one patient underwent primary esophageal end-to-end anastomosis. The median gap between both esophageal ends was six vertebral distance (VD). Seven patients underwent primary anastomosis of the esophagus, and 14 patients underwent gastric replacement. Three patients (13.6%) had anastomotic leakage and 10 patients (45.5%) had anastomotic stenosis. Most of the patients (90.9%) had gastroesophageal reflux, but only two patients required antireflux surgery. The median VD was significantly shorter in E-E group than in E-G group (3 VD vs. 6 VD). Stenosis was significantly more often in E-E group, but there was no significant difference in leakage and reflux symptoms.
CONCLUSION
The treatment for type A EA can include E-E anastomosis or E-G anastomosis, depending on the length of the end-to-end interval after performing gastrostomy. Appropriate tension and blood flow in the anastomosis site are essential for preventing postoperative stenosis and leakage, and esophageal replacement with gastric tube is believed to be feasible and safe in cases where excessive tension is present.

Keyword

Esophageal atresia; Operations

MeSH Terms

Anastomotic Leak
Birth Weight
Constriction, Pathologic
Esophageal Atresia*
Esophagus
Gastroesophageal Reflux
Gastrostomy
Gestational Age
Humans

Reference

1. Maksoud-Filho JG, Goncalves ME, Tannuri U, Maksoud JG. An exclusively intraabdominal distal esophageal segment prevents primary delayed anastomosis in children with pure esophageal atresia. J Pediatr Surg. 2002; 37:1521–1525.

2. Guo W, Fonkalsrud EW, Swaniker F, Kodner A. Relationship of esophageal anastomotic tension to the development of gastroesophageal reflux. J Pediatr Surg. 1997; 32:1337–1340.

3. Puri P, Blake N, O'Donnell B, Guiney EJ. Delayed primary anastomosis following spontaneous growth of esophageal segments in esophageal atresia. J Pediatr Surg. 1981; 16:180–183.

4. Sanal M, Haeussler B, Tabarelli W, Maurer K, Sergi C, Hager J. Pure esophageal atresia with normal outer appearance: case report. J Pediatr Surg. 2007; 42:E1–E3.

5. Humphreys GH, Ferrer JM Jr. Management of esophageal atresia. Am J Surg. 1964; 107:406–411.

6. Howard R, Myers NA. Esophageal atresia: a technique for elongating the upper pouch. Surgery. 1965; 58:725–727.

7. Seguier-Lipszyc E, Bonnard A, Aizenfisz S, Enezian G, Maintenant J, Aigrain Y, et al. The management of long gap esophageal atresia. J Pediatr Surg. 2005; 40:1542–1546.

8. Kim SM, Choi SH, Kim SH, Kwon IK, Han SJ, Oh JT. Esophageal atresia without tracheoesophageal fistula: report of 6 cases. J Korean Assoc Pediatr Surg. 2005; 11:157–164.

9. Ahmad SA, Sylvester KG, Hebra A, Davidoff AM, McClane S, Stafford PW, et al. Esophageal replacement using the colon: is it a good choice? J Pediatr Surg. 1996; 31:1026–1030.

10. Spitz L, Kiely E, Sparnon T. Gastric transposition for esophageal replacement in children. Ann Surg. 1987; 206:69–73.

11. Anderson KD, Randolph JG. Gastric tube interpostion: a satisfactory alternative to the colon for esophageal replacement in children. Ann Thorac Surg. 1978; 25:521–525.

12. Saeki M, Tsuchida Y, Ogata T, Nakano M, Akiyama H. Long-term results of jejunal replacement of the esophagus. J Pediatr Surg. 1988; 23:483–489.

13. Lam KH, Lim ST, Wong J, Lam SK, Ong GB. Gastric histology and function in patients with intrathoracic stomach replacement after esophagectomy. Surgery. 1979; 85:283–290.

14. Chittmittrapap S, Spitz L, Kiely EM, Brereton RJ. Anastomotic leakage following surgery for esophageal atresia. J Pediatr Surg. 1992; 27:29–32.

15. Holder TM, Cloud DT, Lewis JE Jr, Pilling GP 4th. Esophageal atresia and tracheoesophageal fistula: a survey of its members by the surgical section of the American Academy of Pediatrics. Pediatrics. 1964; 34:542–549.

16. Bagolan P, Iacobelli Bd Bd, De Angelis P, di Abriola GF, Laviani R, Trucchi A, et al. Long gap esophageal atresia and esophageal replacement: moving toward a separation? J Pediatr Surg. 2004; 39:1084–1090.

17. Ein SH, Shandling B, Heiss K. Pure esophageal atresia: outlook in the 1990s. J Pediatr Surg. 1993; 28:1147–1150.

18. Chun YS, Jung SE, Lee SC, Park KW, Kim WK. Seventeen year's experience with ninety-six esophageal atresia. J Korean Assoc Pediatr Surg. 1995; 1:140–148.

19. Cho SH, Oh BS, Lee DJ. End to end anastomosis of type A(long gap) esophageal atresia in 1200 gram premature baby: a case report. Korean J Thorac Cardiovasc Surg. 1997; 30:236–240.

20. Rescorla FJ, West KW, Scherer LR 3rd, Grosfeld JL. The complex nature of type A (long-gap) esophageal atresia. Surgery. 1994; 116:658–664.

21. Chun YS, Kim WK. Surgeon's technique and anastomotic stricture after repair of esophageal atresia. Inje Med J. 2002; 23:263–268.

22. Holder TM, Ashcraft KW, Sharp RJ, Amoury RA. Care of infants with esophageal atresia, tracheoesophageal fistula, and associated anomalies. J Thorac Cardiovasc Surg. 1987; 94:828–835.

23. Puri P, Ninan GK, Blake NS, Fitzgerald RJ, Guiney EJ, O'Donnell B. Delayed primary anastomosis for esophageal atresia: 18 months to 11 years follow-up. J Pediatr Surg. 1992; 27:1127–1130.

24. Ball WS, Strife JL, Rosenkrantz J, Towbin RB, Noseworthy J. Esophageal strictures in children. Treatment by balloon dilatation. Radiology. 1984; 150:263–264.

25. Said M, Mekki M, Golli M, Memmi F, Hafsa C, Braham R, et al. Balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia. Br J Radiol. 2003; 76:26–31.

26. Lang T, Hummer HP, Behrens R. Balloon dilation is preferable to bougienage in children with esophageal atresia. Endoscopy. 2001; 33:329–335.

27. Parolini F, Leva E, Morandi A, Macchini F, Gentilino V, Di Cesare A, et al. Anastomotic strictures and endoscopic dilatations following esophageal atresia repair. Pediatr Surg Int. 2013; 29:601–605.

28. Burjonrappa S, Thiboutot E, Castilloux J, St-Vil D. Type A esophageal atresia: a critical review of management strategies at a single center. J Pediatr Surg. 2010; 45:865–871.

29. Antoniou D, Soutis M, Christopoulos-Geroulanos G. Anastomotic strictures following esophageal atresia repair: a 20-year experience with endoscopic balloon dilatation. J Pediatr Gastroenterol Nutr. 2010; 51:464–467.

30. Sri Paran T, Decaluwe D, Corbally M, Puri P. Long-term results of delayed primary anastomosis for pure oesophageal atresia: a 27-year follow up. Pediatr Surg Int. 2007; 23:647–651.