Evolution of left-sided thoracoscopic approach for long gap esophageal atresia repair
Copyright © 2022 Elsevier Inc. All rights reserved..
BACKGROUND: Left-sided repair for long gap esophageal atresia (LGEA) has been described for patients with a large leftward upper pouch, no thoracic tracheoesophageal fistula (TEF) nor tracheobronchomalacia (TBM), or as salvage plan after prior failed right-sided repair. We describe our experience with left-sided MIS traction induced growth process.
METHODS: We retrospectively reviewed patients who underwent Foker process for LGEA at two institutions between December 2016 and November 2021. Patient characteristics, surgical techniques, and outcomes were reviewed.
RESULTS: 71 patients underwent Foker process. Of 34 MIS cases, 28 patients (82%) underwent left-sided repair (median gap length 5 cm) at median age 4 months with median 3 (range 2-8) operations and median 13.5 (IQR 11-21) days on traction until esophageal anastomosis. 9 patients (32%) underwent completely MIS approach, whereas 5 patients (18%) converted to open at first operation and 14 patients (50%) converted to open later in the traction process. Traction was internal in 68%, external in 11%, and combination in 21%. Median follow-up was 15.4 (IQR 7.5-31.7) months after anastomosis. 14% had anastomotic leak managed with antibiotics and/or esophageal vacuum therapy. Median number of esophageal dilations was 3.5 (range 0-13). 18% required stricture resection. 39% underwent Nissen fundoplication. None have needed esophageal replacement.
CONCLUSIONS: For multiple reasons including the tendency of both esophageal pouches to have a leftward bias, less tracheal compression by upper pouch, and clean field of surgery for reoperative cases, we now more commonly use left-sided approach for MIS LGEA repair compared to right side, regardless of left aortic arch.
LEVEL OF EVIDENCE: Level IV Treatment Study.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:58 |
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| Enthalten in: |
Journal of pediatric surgery - 58(2023), 4 vom: 28. Apr., Seite 629-632 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Shieh, Hester F [VerfasserIn] |
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| Links: |
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| Themen: |
Esophageal atresia |
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| Anmerkungen: |
Date Completed 23.03.2023 Date Revised 23.03.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jpedsurg.2022.12.020 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM35217725X |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Left-sided repair for long gap esophageal atresia (LGEA) has been described for patients with a large leftward upper pouch, no thoracic tracheoesophageal fistula (TEF) nor tracheobronchomalacia (TBM), or as salvage plan after prior failed right-sided repair. We describe our experience with left-sided MIS traction induced growth process | ||
| 520 | |a METHODS: We retrospectively reviewed patients who underwent Foker process for LGEA at two institutions between December 2016 and November 2021. Patient characteristics, surgical techniques, and outcomes were reviewed | ||
| 520 | |a RESULTS: 71 patients underwent Foker process. Of 34 MIS cases, 28 patients (82%) underwent left-sided repair (median gap length 5 cm) at median age 4 months with median 3 (range 2-8) operations and median 13.5 (IQR 11-21) days on traction until esophageal anastomosis. 9 patients (32%) underwent completely MIS approach, whereas 5 patients (18%) converted to open at first operation and 14 patients (50%) converted to open later in the traction process. Traction was internal in 68%, external in 11%, and combination in 21%. Median follow-up was 15.4 (IQR 7.5-31.7) months after anastomosis. 14% had anastomotic leak managed with antibiotics and/or esophageal vacuum therapy. Median number of esophageal dilations was 3.5 (range 0-13). 18% required stricture resection. 39% underwent Nissen fundoplication. None have needed esophageal replacement | ||
| 520 | |a CONCLUSIONS: For multiple reasons including the tendency of both esophageal pouches to have a leftward bias, less tracheal compression by upper pouch, and clean field of surgery for reoperative cases, we now more commonly use left-sided approach for MIS LGEA repair compared to right side, regardless of left aortic arch | ||
| 520 | |a LEVEL OF EVIDENCE: Level IV Treatment Study | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Esophageal atresia | |
| 650 | 4 | |a Internal traction | |
| 650 | 4 | |a Left-sided thoracoscopic repair | |
| 650 | 4 | |a Long gap | |
| 700 | 1 | |a Hamilton, Thomas E |e verfasserin |4 aut | |
| 700 | 1 | |a Manfredi, Michael A |e verfasserin |4 aut | |
| 700 | 1 | |a Ngo, Peter D |e verfasserin |4 aut | |
| 700 | 1 | |a Wilsey, Michael J |e verfasserin |4 aut | |
| 700 | 1 | |a Yasuda, Jessica L |e verfasserin |4 aut | |
| 700 | 1 | |a Zendejas, Benjamin |e verfasserin |4 aut | |
| 700 | 1 | |a Smithers, C Jason |e verfasserin |4 aut | |
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