Thoracoscopic external traction suture elongation for the management of long-gap oesophageal atresia: a two-centre experience
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In brief
In brief
This two-center retrospective study reports outcomes of thoracoscopic external traction suture elongation (Van der Zee technique) in 10 long-gap esophageal atresia patients, with or without distal tracheoesophageal fistula. All patients achieved esophageal continuity without requiring esophagostomy, with median 6 days between first traction and final anastomosis.
- Thoracoscopic external traction sutures successfully achieved primary anastomosis in all 10 LGOA cases, avoiding oesophagostomy.
- Technique works for both pure atresia (Gross A/B) and long-gap cases with distal TOF (type C), median 3 traction procedures needed.
- Median time from first traction to final anastomosis was 6 days; all patients achieved oral feeding at 12-52 month follow-up.
- Thoracoscopic approach provides superior visualization and maintains consistent tension after chest closure compared to open techniques.
- Three anastomotic leaks occurred but were managed conservatively; four cases required conversion to thoracotomy at third procedure.
Written by the GCMD Library team from the article.
Abstract
Aim
Van der Zee (VdZ) described a technique to elongate the oesophagus in long-gap oesophageal atresia (LGOA) by thoracoscopic placement of external traction sutures (TPETS). Here, we describe our experience of using this technique.
Method
Retrospective review of all LGOA + / − distal tracheo-oesophageal fistula (dTOF) cases where TPETS was used in our institutions. Data are given as medians (IQR).
Results
From 01/05/2019 to 01/03/2023, ten LGOA patients were treated by the VdZ technique. Five had oesophageal atresia (Gross type A or B, Group 1) and five had OA with a dTOF (type C, Group 2) but with a long gap precluding primary anastomosis.
Age of first traction procedure was Group 1 = 53 (29–55) days and Group 2 = 3 (1–49) days. Median number of traction procedures = 3; time between first procedure and final anastomosis was 6 days (4–7). Four cases were converted to thoracotomy at the third procedure. Three had anastomotic leaks managed conservatively.
Follow-up was 12–52 months. All patients achieved oesophageal continuity and were orally fed; no patient required an oesophagostomy.
Conclusion
In this series, TPETS in LGOA facilitated delayed primary anastomoses and replicated the good results previously described but, in addition, was successful in cases with dTOF. We believe traction suture placement and tensioning benefit from being performed thoracoscopically because of excellent visualisation and the fact that the tension does not change when the chest is closed. Surgical and anaesthetic planning and expertise are crucial. It is now our management of choice in OA patients with a long gap with or without a distal TOF.