Repair of long-gap esophageal atresia: gastric conduits may improve outcome-a 20-year single center experience.
BACKGROUND
Treatment of long-gap esophageal atresia (LEA) is a major challenge. Options for reconstruction include native esophagus, or replacement with stomach, colon, or small intestine. However, debate continues regarding the optimal conduit for esophageal replacement.


METHODS
Medical records of patients with a diagnosis of esophageal atresia during a 20-year period were reviewed.


RESULTS
Twenty-eight cases of LEA were identified. Ten patients underwent primary anastomosis either after serial pouch dilations (9/10) and/or after a lengthening procedure (2/10). Nine received colonic interpositions, and the remainder were reconstructed with a gastric tube (n = 3), or gastric interposition (n = 2). One patient died prior to repair, and two await definitive treatment. Repeat esophageal reconstruction was required in four patients because of conduit ischemia. Two ischemic events occurred in the colonic interposition group, and two in the native esophageal repairs. All patients, except one who relocated, received long-term follow-up (mean 4.2 years: range 0.5-11.5 years).


CONCLUSIONS
Surgeon's expertise and patient's anatomy should be considered when selecting an appropriate operation for LEA. Although native esophagus is generally preferred, it is associated with a high rate of stricture. Although our study has a limited by numbers, we found that patients with gastric conduits had lower complication rates and no conduit ischemia. We suggest that gastric transposition may be favored as an initial reconstructive option.
Hunter
Catherine J
CJ
Childrens Hospital Los Angeles, Los Angeles, USA.
Petrosyan
Mikael
M
Connelly
Meghan E
ME
Ford
Henri R
HR
Nguyen
Nam X
NX
D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery; D004933:Esophageal Atresia / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D019736:Prostheses and Implants; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery
J Pediatr Surg. 2000 Dec;35(12):1830-2
11101748
Ann Surg. 1987 Jul;206(1):69-73
3606233
J Pediatr Surg. 2005 Dec;40(12):e1-4
16338286
Dis Esophagus. 2008;21(1):73-7
18197943
J Thorac Cardiovasc Surg. 1982 Jun;83(6):918-27
7087521
Eur J Pediatr Surg. 1995 Aug;5(4):206-10
7577857
Eur J Pediatr Surg. 2003 Aug;13(4):224-30
13680489
J Pediatr Surg. 2007 Mar;42(3):500-4
17336187
Ann Thorac Surg. 1994 Mar;57(3):576-9
8147624
J Pediatr Surg. 1992 Jan;27(1):29-32
1552439
Eur J Pediatr Surg. 2007 Aug;17(4):278-81
17806027
J Pediatr Surg. 2006 Oct;41(10):1635-40
17011260
Teratology. 1987 Dec;36(3):363-9
3424224
Surgery. 1992 Feb;111(2):131-6
1736381
Ann Thorac Surg. 1977 Jan;23:62-6
831646
J Pediatr Surg. 2000 Feb;35(2):279-81; discussion 282
10693681
J Pediatr Surg. 2003 Jan;38(1):53-7; discussion 53-7
12592618
Can Assoc Radiol J. 1997 Aug;48(4):259-64
9282158
Ann Thorac Surg. 2002 Nov;74(5):1708-11
12440643
Ann Saudi Med. 2006 Mar-Apr;26(2):116-9
16761448
J Pediatr Surg. 2005 Oct;40(10):1542-6
16226981
Ann Surg. 1997 Oct;226(4):533-41; discussion 541-3
9351721
Minerva Pediatr. 2006 Feb;58(1):9-13
16541002
Scand J Thorac Cardiovasc Surg. 1972;6(2):206-14
5046346
Rev Hosp Clin Fac Med Sao Paulo. 1999 Jan-Feb;54(1):9-16
10488595
J Pediatr Surg. 1994 Nov;29(11):1434-8
7844715
J Pediatr Surg. 2004 Jul;39(7):1084-90
15213904
J Med Assoc Thai. 2000 Apr;83(4):352-7
10808693