A NOVEL TECHNIQUE FOR LONG GAP ESOPHAGEAL ATRESIA SURGERY: COLONIC TRANSPOSITION WITHOUT CERVICAL ESOPHAGOSTOMY
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1
Istanbul Medeniyet University Medical School, Türkiye
Introduction: An initial cervical esophagostomy is done before colonic replacement surgery in long gap esophageal atresia (EA) patients. Esophagostomy may itself cause complications before and after the definitive surgery.
Aim: Presentation of a clinical experience on esophageal colonic replacement surgery without cervical esophagostomy.
Methods: A retrospective analysis for the years 2010-2016 was done. Among the four male and one female patients, four had isolated EA and one had EA with proximal fistula. Their mean birth weight was 2200 (1420-3530) g. After an initial Stamm gastrostomy, the definitive surgery was done at a mean of 5.5 (3-10) months with a mean weight of 6 (4.5-8) kg. Through a right thoracotomy incision, the proximal pouch was dissected free. An exploration revealed no distal esophageal pouch in four. A left colonic segment in three and transverse colonic segment in the two were prepared and brought up to chest via transhiatal route in an isoperistaltic manner. The proximal esophagocolonic anastomosis was done within the thorax. The distal gastric anastomosis was done behind the stomach in four and the distal stump was used in one. The early postoperative course was uneventful. A proximal anastomotic stricture needed dilatations in one patient. The mean follow up period is 24 (1-65) months. The first three patients are fully and the two recently operated ones partially fed orally by age-appropriate diet.
Conclusion: Protection of proximal esophageal pouch intact eliminated the need of working in the cervical region. The proximal anastomosis was kept within the thorax preventing any compressive force that might act on esophagus at the level of thoracic inlet with the potential to impair vascularity. Moreover, the patients had the chance of using a much longer segment of their native esophagus. Long term clinical follow-up in three showed a quite satisfactory result in terms of swallowing and feeding.
Keywords:
ESOPHAGEAL ATRESİA,
Children,
Long gap,
Surgery,
Colon interposition,
Esophagostomy
Conference:
4th International Conference on Oesophageal Atresia / 15-16 September 2016 / Sydney Australia, Sydney, Australia, 15 Sep - 22 Nov, 2016.
Presentation Type:
Poster
Topic:
Difficult surgical decisions in OA
Citation:
Durakbasa
CU,
Mutuş
M,
Gerçel
G,
Fettahoğlu
S and
Okur
H
(2017). A NOVEL TECHNIQUE FOR LONG GAP ESOPHAGEAL ATRESIA SURGERY: COLONIC TRANSPOSITION WITHOUT CERVICAL ESOPHAGOSTOMY.
Front. Pediatr.
Conference Abstract:
4th International Conference on Oesophageal Atresia / 15-16 September 2016 / Sydney Australia.
doi: 10.3389/conf.FPED.2017.01.000021
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Received:
13 Sep 2016;
Published Online:
11 Dec 2017.
*
Correspondence:
Prof. Cigdem U Durakbasa, Istanbul Medeniyet University Medical School, istanbul, Türkiye, cigdemulukaya@yahoo.com