A single centre experience using internal traction sutures in managing long gap oesophageal atresia
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Read the article on jpedsurg.org ↗Article · May 2022 · 1 min read
In brief
In brief
Single-center retrospective review of 7 infants with long gap oesophageal atresia managed with internal traction sutures (ITS) found significant complications including intrathoracic leaks and adhesions. All thoracoscopic cases required conversion to thoracotomy, with only 4 achieving delayed primary anastomosis. The technique was abandoned due to poor outcomes.
Written by the GCMD Library team from the article.
Aim
Thoracoscopically placed internal traction sutures (ITS) for the initial management of long gap oesophageal atresia (LGOA), not amenable to primary anastomosis, was first described in 2015. Here we describe our experience using ITS both thoracoscopically and at thoracotomy where the gap between upper and lower oesophagus is too wide for primary anastomosis.
Method
The case notes of all infants treated with ITS for oesophageal atresia (01/10/2015 to 01/12/2019) were reviewed. Gaps considered too wide for an anastomosis had ITS placed between the two pouches as described by Patkowski in 2015. All patients were gastrostomy fed. Patients returned to theatre with an expectation to complete the anastomosis or re-tighten the traction sutures.
Results
Seven patients (4 OA, 1 OA with proximal fistula, 2 OA/distal TOF) median birthweight 2.28 kg (1.2–3.6 kg) were managed using ITS. Median gap length 4.5 (3–9) vertebral bodies. ITS were placed thoracoscopically in 5 cases and at thoracotomy in 2 at median 46 days (1–120) old. In all cases, ITS was associated with significant intra-thoracic adhesions. Five patients leaked from the traction sutures. Four patients had a delayed primary anastomosis performed at thoracotomy and 3 required a cervical oesophagostomy. The median length of stay was 159 days (98–282). All patients started thoracoscopically eventually required thoracotomy.
Conclusion
The use of ITS in our department was associated with significant complications, particularly intra-thoracic leaks and adhesions. In our hands ITS did not improve the feasibility of thoracoscopic repair for LGOA and has been abandoned by us.