Application of esophageal elongation in repairing long-gap esophageal atresia

Abstract

Objective To summarize the clinical experience of repairing long-gap esophageal atresia (LGEA) after various methods of esophageal elongation. Methods Clinical data were retrospectively analyzed for 10 hospitalized LGEA cases from January 2016 to June 2017. Their average gestational age was (38.3±1.9) weeks and average birth weight (2846±699) grams. The clinical types were esophageal atresia with trachea-esophageal fistula (type Ⅲ, n=6) with 2.7±0.2 cm in gap length and isolated esophageal atresia (type I, n=4) with 4.5±1.0 cm in gap length. Five cases achieved primary anastomosis after elongation of intraoperative traction. And another five cases underwent delayed primary anastomosis plus elongation strategies of spontaneous growth (n=3), internal bougienage stretching technique (n=1) and external traction with Foker procedure (n=1). Results Anastomotic leakage in 40% (4/10) cases recovered after conservative measures. The overall follow-up period was 7 to 18 months. The postoperative complications were anastomotic strictures (50%, a mean of 1.6 dilating episodes), tracheomalacia (30%), severe malnutrition (30%) and severe gastric-esophageal reflux (10%). Conclusions Primary repair of long-gap esophageal atresia may be accomplished by specialized esophageal lengthening. And tracheomalacia and malnutrition should be focused postoperatively. Key words: Esophageal atresia; Treament; Esophageal elongation