Surgical repair of long-gap esophageal atresia: A retrospective study comparing the management of long-gap esophageal atresia in the Nordic countries

Tatjana Stadil; Antti Koivusalo; Mikko Pakarinen; Audun Mikkelsen; Ragnhild Emblem; Jan F Svensson; Henrik Ehrén; Linus Jönsson; Jakob Bäckstrand; Helene Engstrand Lilja; Felipe Donoso; Jørgen Mogens Thorup; Thorstein Sæter; Lars Rasmussen; Rikke Neess Pedersen; Pernilla Stenström; Einar Arnbjörnsson; Kristján Óskarsson; Niels Qvist

doi:10.1016/j.jpedsurg.2018.07.023

Surgical repair of long-gap esophageal atresia: A retrospective study comparing the management of long-gap esophageal atresia in the Nordic countries

J Pediatr Surg. 2019 Mar;54(3):423-428. doi: 10.1016/j.jpedsurg.2018.07.023. Epub 2018 Sep 1.

Authors

Tatjana Stadil¹, Antti Koivusalo², Mikko Pakarinen³, Audun Mikkelsen⁴, Ragnhild Emblem⁵, Jan F Svensson⁶, Henrik Ehrén⁷, Linus Jönsson⁸, Jakob Bäckstrand⁹, Helene Engstrand Lilja¹⁰, Felipe Donoso¹¹, Jørgen Mogens Thorup¹², Thorstein Sæter¹³, Lars Rasmussen¹⁴, Rikke Neess Pedersen¹⁵, Pernilla Stenström¹⁶, Einar Arnbjörnsson¹⁷, Kristján Óskarsson¹⁸, Niels Qvist¹⁹

Affiliations

¹ Surgical Department A, Odense University Hospital, Odense, Denmark. Electronic address: [email protected].
² Dept. of Pediatric Surgery, Children's Hospital, University of Helsinki, Helsinki, Finland. Electronic address: [email protected].
³ Dept. of Pediatric Surgery, Children's Hospital, University of Helsinki, Helsinki, Finland. Electronic address: [email protected].
⁴ Dept. of Gastric and Pediatric Surgery, Oslo University Hospital, Rikshospitalet and Ullevål, Oslo, Norway. Electronic address: [email protected].
⁵ Dept. of Gastric and Pediatric Surgery, Oslo University Hospital, Rikshospitalet and Ullevål, Oslo, Norway. Electronic address: [email protected].
⁶ Department of Pediatric Surgery, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden. Electronic address: [email protected].
⁷ Department of Pediatric Surgery, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden. Electronic address: [email protected].
⁸ Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden. Electronic address: [email protected].
⁹ Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden. Electronic address: [email protected].
¹⁰ Department of Pediatric Surgery, Children's Hospital and Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. Electronic address: [email protected].
¹¹ Department of Pediatric Surgery, Children's Hospital and Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. Electronic address: [email protected].
¹² Dept. of Pediatric Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Electronic address: [email protected].
¹³ Dept. of Pediatric Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. Electronic address: [email protected].
¹⁴ Surgical Department A, Odense University Hospital, Odense, Denmark. Electronic address: [email protected].
¹⁵ Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark. Electronic address: [email protected].
¹⁶ Dept. of Pediatrics, Children's Hospital, Lund University, Lund, Sweden. Electronic address: [email protected].
¹⁷ Dept. of Pediatrics, Children's Hospital, Lund University, Lund, Sweden. Electronic address: [email protected].
¹⁸ Children's Hospital, University Hospital, Reykjavik, Iceland. Electronic address: [email protected].
¹⁹ Surgical Department A, Odense University Hospital, Odense, Denmark; Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark. Electronic address: [email protected].

PMID: 30220451
DOI: 10.1016/j.jpedsurg.2018.07.023

Abstract

Background: Several surgical procedures have been described in the reconstruction of long-gap esophageal atresia (LGEA). We reviewed the surgical methods used in children with LGEA in the Nordic countries over a 15-year period and the postoperative complications within the first postoperative year.

Methods: Retrospective multicenter medical record review of all children born with Gross type A or B esophageal atresia between 01/01/2000 and 12/31/2014 reconstructed within their first year of life.

Results: We included 71 children; 56 had Gross type A and 15 type B LGEA. Delayed primary anastomosis (DPA) was performed in 52.1% and an esophageal replacement procedure in 47.9%. Gastric pull-up (GPU) was the most frequent procedure (25.4%). The frequency of chromosomal abnormalities, congenital heart defects and other anomalies was significantly higher in patients who had a replacement procedure. The frequency of gastroesophageal reflux (GER) was significantly higher after DPA compared to esophageal replacement (p = 0.013). At 1-year follow-up the mean body weight was higher after DPA than after organ interposition (p = 0.043).

Conclusion: DPA and esophageal replacement procedures were equally applied. Postoperative complications and follow-up were similar except for the development of GER and the body weight at 1-year follow-up. Long-term results should be investigated.

Type of study: Treatment study.

Level of evidence: Level III.

Keywords: Esophageal atresia; Gross type A; Gross type B; Long gap; Postoperative complication; Surgical repair.

Publication types

Multicenter Study

MeSH terms

Anastomosis, Surgical / adverse effects
Anastomosis, Surgical / methods
Esophageal Atresia / surgery*
Esophagoplasty / adverse effects
Esophagoplasty / methods*
Esophagus / surgery
Humans
Infant
Infant, Newborn
Postoperative Complications / epidemiology
Replantation / statistics & numerical data
Retrospective Studies
Scandinavian and Nordic Countries
Treatment Outcome