The surgical approach to esophageal atresia repair and the management of long-gap atresia: results of a survey.
The optimal approach for esophageal atresia (OA) repair and technique used for long-gap OA repair are controversial. There are few data comparing the outcomes of the different approaches and techniques. We performed a survey of current practice of 88 pediatric surgeons and asked experts to provide us with definitions and rationales behind their management strategies. There were no differences between UK and non-UK surgeons. Although the majority of pediatric surgeons perform minimally invasive surgery (68%), only 16% have performed thoracoscopic OA repair; however, 46% are planning to carry out thoracoscopic OA repair. Gastric interposition is the most preferred technique for long-gap OA when primary anastomosis is not possible, with 94% of those surgeons who use the technique satisfied with it. Growth of the esophageal ends by traction is the other major technique used, but only 76% of surgeons who use it are satisfied with it. Most surgeons repair < or =2 patients with long-gap OAs per year. Long-gap OA should be managed by a limited number of surgeons at each center. Even among experts, there is little consensus on the definition of or the optimum technique for repair of long-gap OA.
Ron
Ori
O
Department of Paediatric Surgery, Institute of Child Health & Great Ormond Street Hospital, London, United Kingdom.
De Coppi
Paolo
P
Pierro
Agostino
A
D000714:Anastomosis, Surgical; D003106:Colon / Q000637:transplantation; D004933:Esophageal Atresia / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D019538:Health Care Surveys; D006801:Humans; D007583:Jejunum / Q000637:transplantation; D013270:Stomach / Q000637:transplantation*; D013536:Suture Techniques; D013906:Thoracoscopy; D013907:Thoracostomy; D014143:Traction