title: Long-gap oesophageal atresia: comparison of delayed primary anastomosis and oesophageal replacement with gastric tube.
abstract: BACKGROUND
  Long-gap oesophageal atresia (LGOA) causes significant early and long-term morbidity. We conducted a retrospective 25-year review comparing outcomes of delayed primary anastomosis versus oesophageal replacement with greater curvature gastric tube.
  
  
  METHODS
  Records of 44 consecutive patients undergoing LGOA repair (1986-2010) were obtained from OA database with ethics approval and were analysed for complication and long-term outcomes. Analysis was conducted using Student's t-test for quantitative and Fisher exact test for qualitative data.
  
  
  RESULTS
  Thirty (68%) patients underwent delayed primary anastomosis and 14 (32%) had oesophageal replacement. Oesophageal replacement patients had longer gaps (mean 5.5 vertebrae, range 4-9) compared to delayed primary anastomosis (mean 3.9, range 2-6) (p=0.004), but no difference in perioperative complications (p=0.2) (Table 1). Oesophageal replacement had more long-term complications (86%) compared to delayed primary anastomosis (30%) (p=0.005). Almost all patients (>90%) experienced gastro-oesophageal reflux and 21 delayed primary anastomosis patients (70%) underwent fundoplication. 60% of delayed primary anastomosis and 64.3% of oesophageal replacement patients had continued gastrointestinal symptoms years after repair.
  
  
  CONCLUSIONS
  Our experience indicates that LGOA can be repaired safely using both methods, with no deaths and similar perioperative risk, but high long-term morbidity mandates long-term follow-up of these patients. Delayed primary anastomosis has a better long-term outcome compared to oesophageal replacement with gastric tube.
authors.affiliation: Department of Paediatric and Neonatal Surgery, Royal Children's Hospital, Flemington Road, Parkville Victoria 3052, Australia.
authors.forename: Hui Qing
authors.initials: HQ
authors.lastname: Lee
authors.affiliation: Department of Paediatric and Neonatal Surgery, Royal Children's Hospital, Flemington Road, Parkville Victoria 3052, Australia.
authors.forename: Alisa
authors.initials: A
authors.lastname: Hawley
authors.affiliation: Department of Paediatric and Neonatal Surgery, Royal Children's Hospital, Flemington Road, Parkville Victoria 3052, Australia.
authors.forename: Joe
authors.initials: J
authors.lastname: Doak
authors.affiliation: Department of Paediatric and Neonatal Surgery, Royal Children's Hospital, Flemington Road, Parkville Victoria 3052, Australia.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Nightingale
authors.affiliation: Department of Urology, Royal Children's Hospital; Department of Paediatrics, University of Melbourne; Douglas Stephens Laboratory, Murdoch Children's Research Institute. Electronic address: John.Hutson@rch.org.au.
authors.forename: John M
authors.initials: JM
authors.lastname: Hutson
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000295:instrumentation*; D004933:Esophageal Atresia / Q000628:therapy*; D004944:Esophagoplasty / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D013997:Time Factors; D055815:Young Adult
keywords: Delayed primary anastomosis; Long gap; Oesophageal atresia; Oesophageal replacement