DOZ047.59: Development of operational tactics for esophageal atresia in the Republic of Tatarstan (Russia)

Abstract

Abstract The Children's Republican Hospital of Kazan was opened in 1977 with the participation of prof. Rokytskyi, with rapid thoracic surgery development. In atresia of the esophagus, right-sided median thoracotomy, ligation of the tracheoesophageal fistula, Hayat esophagoplasty were performed. The duration of the operation was 2–3-4 h. With the installation of a pleural drainage for 2–3 weeks and a nasogastric tube for 1 month. When radical surgery was impossible, the upper and lower esophagostomas were applied, followed by coloesophagoplasty in 2–3 years. In 2003, the reconstruction and renovation of the surgical and resuscitation departments for neonates began. A new neonatal surgery team had been formed, studying in Ospedale Giannina Gaslini, Genova, Italy and St. Petersburg, Russia. As a result we introduced a single-row suture into the neonatal surgery for esophagoplasty. The duration of drainage was 7–10 days, the duration of the nasogastric tube was 2 weeks. The duration of hospital stay was reduced to 1–1.5 months. Another, ‘stormy’ development of neonatal surgery has undergone in 2013. The accumulated experience in the open surgery of the esophagus allowed us to begin to perform thoracoscopic esophagoplasty. Starting from 2013, more than 20 patients are operated annually with esophageal atresia of various forms. Mortality of about 3% in 5 years. We perform thoracoscopy, ligation and resection of tracheoesophageal fistula, end-to-end esophagoplasty with various diastasis. Esophageal anastomosis nodular extracarporal single row. The minimum weight of a patient with thoracoscopic esophagoplasty is 1200 g. The term draining of the pleural cavity is 3–5 days. A complicated group of patients consists of newborns with Long Gap. The final choice of surgical tactics is not yet decided. The primary and obligatory operation that is performed in LG is gastrostomy to feed the patient, with previous thoracoscopy and resection of the tracheoesophageal fistula with type 3 esophageal atresia. At the age of 2 weeks, gastroscopy and gastrography are performed in order to determine the diastasis between the esophagus. In conclusion, it is necessary to say the following. We consider thoracoscopic access for esophageal pathology as optimal, providing the patient with weighs more than 1200 g and without no concomitant pathology.