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

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.