Staged thoracoscopic treatment of longgap esophageal atresia without the need for a gastrostomy

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Abstract


Introduction. Primary reconstruction of long gap esophageal atresia still represents a serious surgical issue. A variety of treatment options including preservation of native esophagus or its replacement for other segments of the digestive tract shows that the condition is difficult to treat and that a single approach is lacking. Until recently, all children with long gap esophageal atresia required a temporary gastrostomy to provide nutrition during lengthening of the existing esophagus. This study presents a new therapeutic approach when thoracoscopic elongation of the esophagus by traction can be performed without a gastrostomy. Materials and methods. Two cases of long gap esophageal atresia were reported in children who underwent treatment at the Center of Neonatal Surgery of Ivan and Matryona City Children’s Hospital in Irkutsk from 2017 to 2018. Internal sutures were applied using thoracoscopy with subsequent remote esophageal anastomosis that was also performed with the help of thoracoscopy. The treatment was estimated through the possibility of anastomosis application, anastomosis complications and interval of a patient’s transition to oral feeding. Results. The esophageal traction lasted 5 and 6 days, respectively. Both patients had native esophagus preserved without the need for a gastrostomy. Neither patient had anastomosis leakage. Feeding via the nasogastric tube started at days 6 and 7 after the surgery. Oral feeding was possible at days 30 and 35 after anastomosis construction. Anastomotic stenosis was developed in two patients and required 3 and 4 sessions of balloon dilatation. At 12-month follow-up, the patients’ food regimen was similar to that of their peers. Conclusions. The presented method of esophageal traction without the need for a gastrostomy must be considered as an alternative treatment strategy of long gap esophageal atresia.

About the authors

Yu. A. Kozlov

Irkutsk Municipal Pediatric Clinical Hospital; Irkutsk State Medical Academy of Continuing Education; Irkutsk State Medical University Russia

Author for correspondence.
Email: yuriherz@hotmail.com
ORCID iD: 0000-0003-2313-897X

Russian Federation

Yury A. KOZLOV – Dr. Sci.(Med), head of department of neonatal surgery at Irkutsk Municipal Pediatric Clinical Hospital; professor of the department of pediatric surgery at Irkutsk State Medical University Russia; professor of the department of pediatric surgery at Irkutsk State Medical Academy of Continuing Education

Sovetskaya 57, Irkutsk, 664009
Krasnogo Vosstaniya st., 1, Irkutsk, 664003 

A. A. Rasputin

Irkutsk Municipal Pediatric Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0002-5690-790X

Russian Federation

Andrey A. RASPUTIN – Surgeon of department of neonatal surgery

Sovetskaya 57, Irkutsk, 664009

P. Jh. Baradieva

Irkutsk Municipal Pediatric Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0002-5463-6763

Russian Federation

Polina Jh. BARADIEVA – Pedaitric surgeon

Sovetskaya 57, Irkutsk, 664009

Ch. B. Ochirov

Irkutsk Municipal Pediatric Clinical Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0002-6045-1087

Russian Federation

Chimit B. OCHIROV – Surgeon of department of neonatal surgery

Sovetskaya 57, Irkutsk, 664009

V. S. Cheremnov

Irkutsk State Medical University Russia

Email: fake@neicon.ru
ORCID iD: 0000-0001-6135-4054

Russian Federation

Cheremnov V. VLADISLAV – Clinical ordinator of department of pediatric surgery

Krasnogo Vosstaniya st., 1, Irkutsk, 664003

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