Impact of an external lengthening procedure on the outcome of long-gap esophageal atresia at our hospitals.
OBJECTIVE
To demonstrate the outcome of external lengthening for long-gap esophageal atresia (LGEA) at our hospitals.


METHODS
Five patients with LGEA underwent external lengthening between 2010 and 2014 (group A), and 11 patients with LGEA underwent other lengthening techniques between 1990 and 2011 (group B). We compared the procedure and outcome between these two groups.


RESULTS
The mean birth weight was 2001 g in group A and 2485 g in group B (p = 0.06). The mean age at esophageal reconstruction was 28 days in group A and 227 days in group B (p = 0.03). Although primary esophageal anastomosis without myotomy was feasible in all patients in group A, a myotomy was needed for primary esophageal anastomosis in half of the patients in group B. Anastomotic leakage occurred in none in group A and in six patients in group B (p = 0.03). The mean age at the establishment of full oral feeding was 76 days in group A and 686 days in group B (p = 0.009).


CONCLUSIONS
External traction for LGEA can effectively lengthen the esophagus to enable primary anastomosis at an earlier age. This may facilitate oral intake.
Department of Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-0066, Japan. kmochizuki@kcmc.jp.
Kyoko
K
Mochizuki
Department of Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-0066, Japan.
Masato
M
Shinkai
Department of Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-0066, Japan.
Hiroshi
H
Take
Department of Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-0066, Japan.
Norihiko
N
Kitagawa
Department of Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-0066, Japan.
Hidehito
H
Usui
Department of Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-0066, Japan.
Hisayuki
H
Miyagi
Department of Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-0066, Japan.
Kaori
K
Nakamura
Division of Pediatric Surgery, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Masayuki
M
Obatake
D000714:Anastomosis, Surgical; D004933:Esophageal Atresia / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016896:Treatment Outcome
Children; Esophageal atresia; Esophageal lengthening; External traction; Long gap