SURGICAL TACTICS OF SAVING THE NATIVE ESOPHAGUS IN CASE OF LONG GAP ESOPHAGEAL ATRESIA

Abstract

Introduction. The absence of a single surgical tactic for a long gap esophageal atresia (LGEA) treatment as well as frequent unsatisfactory results of applying existing treatment methods urge searching and implementing of a new surgical approach to remediation of malformation. Objective. To optimize surgical treatment of LGEA and provide preservation of native esophagus by elongating and pouches growth inducting. Materials and methods. 6 clinical cases of patients with LGEA who had been treated in National children specialized hospital “Okhmatdyt” during 2018-2019 were analyzed. All patients received staged malformation remediation by elongating of esophagus pouches with traction sutures with further formation of anastomosis. Results. 6 patients with LGEA were surgically treated by esophageal lengthening using the Foker process. The duration of traction varied from 6 to 19 days, the average daily distance of traction of each segment was from 2,4 to 4,8 mm. Segment growth efficiency was observed by diagnostics of metal clips positioning at the ends of esophagus segments on X-ray, or esophagography. In all 6 cases the application of dozed staged traction resulted in esophagus lengthening with elimination of gap from 0-1,0 sm, so that anastomosis of native esophagus was accomplished with the further oral feeding. Conclusions. The method of growth induction allows to overcome a long gap between segments of the atretic esophagus, create conditions for the formation of anastomosis and preserve own esophagus with the restoration of age-related oral nutrition. The concept of induction of esophageal growth eliminates or reduces the use of intestinal plastic of esophagus. The Foker process is an organ-preserving method and is an alternative to operations with loss of an esophagus.