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TÜRKÇE
Poster - 27
Optimizing long-gap esophageal atresia repair: a multicenter retrospective study
D Borselle 1, J Davidson 2, L Magni 3, H Alliot 4, S Tytgat 3, S Loukogeorgakis 5, A Bonnard 4, S Rothenberg 6, PD Coppi 5, D Patkowski 1
1 Department of Pediatric Surgery and Urology, Wroclaw Medical University and Hospital, Borowska, Wroclaw, Poland
2 Stem Cell and Regenerative Medicine Section, Developmental Biology and Cancer Research and teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
3 Department of Pediatric Surgery, Pediatric Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands, Congenital Esophageal and Airway Team Utrecht, Pediatric Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
4 Service de Chirurgie Pédiatrique Viscérale et Urologique, Hôpital Robert Debré, Paris, France
5 Stem Cell and Regenerative Medicine Section, Developmental Biology and Cancer Research and teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK, Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Institute of Child Health, University College London, London, UK
6 Department of Pediatric Surgery, Rocky Mountain Hospital for Children in Denver, US
Introduction: The surgical management of long-gap esophageal atresia (LGEA) remains complex and challenging. This study compares management strategies and clinical outcomes in LGEA patients treated at three high-volume centers.
Methods: A retrospective analysis was conducted on LGEA patients (type A and B) treated between 2008 and 2024. Demographics, surgical treatment, timing of definitive repair and outcomes were collected and analyzed.
Results: A total of 138 patients were included. The surgical approaches involved: thoracoscopic in 111/138 (80.4%) patients (for five patients was open for final procedure), open in 24/138 (17.4%) patients and conversion from thoracoscopic to open in 2/111 (1.8%) patients. The surgical strategies consisted of: primary esophageal anastomosis – 11/138 (8%) patients, esophageal lengthening using internal traction – 40/138 (29%) patients (in 38 patients a full anastomosis was achieved: in 35 using only internal traction technique, while 3 patient required Collis/ Collis-Nissen procedure as definitive management), esophageal lengthening using external traction – 33/138 (23.9%) patients (1 patient required gastric pull-up as the final management), delayed primary anastomosis – 39/138 (28.3%) patients, and esophageal reconstruction – 19/138 (13.8%) patients. Median age at esophageal continuity and median time between the initial procedure and esophageal anastomosis was reduced for esophageal lengthening procedures. There was no surgery-related mortality. 4 patients died before the anastomosis due to concomitant malformations. Postoperative complications included anastomotic leakage, recurrent strictures, and fundoplication requirement. The native esophagus was preserved in 112/133 (84.2%).
Conclusions: Management at high-volume, experienced centers is crucial for optimizing outcomes and preserving the native esophagus in LGEA patients. Thoracoscopic staged esophageal lengthening using either external or internal traction, effectively reduces time to achieve esophageal continuity and the need for esophageal substitution, when primary esophageal anastomosis is not feasible. Early postoperative complications were comparably infrequent across centers, irrespective of the surgical strategy.