The technique was designed to bridge the gap between the esophageal pouches of long gap esophageal tracia, which for me means type A and B, using stage thorachoscopic approach.
Anastomosis is possible if both ends overlap, but care must be taken when deciding. There is no way back. Any failure will result in the loss of part of the esophagus.
Dariusz Patkowski, MD, PhD - Best of the Best in Pediatric Surgery 2024
▶Ep 6 · 0:26
quoteThe technique was designed to bridge the gap between the esophageal pouches of long gap esophageal tracia, which for me means type A and B, using stage thorachoscopic approach.↗
▶Ep 6 · 0:26
clinicalThe technique was designed to bridge the gap between the esophageal pouches of long gap esophageal atresia, which for the presenter means type A and B.↗
▶Ep 6 · 1:00
clinicalAll 27 cases of long gap esophageal atresia were operated thoracoscopically.↗
▶Ep 6 · 1:15
clinicalBoth ends of the esophagus are brought together under tension with internal traction suture using static, not active tension.↗
▶Ep 6 · 1:30
clinicalPreoperative rigid bronchoscopy is a standard procedure to check for upper fistula and any tracheal malformation.↗
▶Ep 6 · 1:40
clinicalThe patient lies in a prone position on the edge of the operating table with the right scapula as the anatomical reference point for trocar placement.↗
▶Ep 6 · 1:55
clinicalThe distal esophagus is usually located at the level of the diaphragm and is dissected bluntly from surrounding tissues.↗
▶Ep 6 · 2:10
clinicalThere is no need to use electrosurgery for dissection of the esophageal pouches and fistula.↗
▶Ep 6 · 2:25
clinicalFor internal traction, a 2-0 non-absorbable braided suture is used.↗
▶Ep 6 · 2:25
clinicalPlacing the internal traction suture requires full thickness of tissue, including the mucosal layer.↗
▶Ep 6 · 2:55
clinicalClips are placed to cover the entire thickness of the tissue and part of the suture to prevent leaks and allow for greater force to be used for traction.↗
▶Ep 6 · 3:40
clinicalSubsequent stages are performed every 1 to 5 days.↗
▶Ep 6 · 3:50
clinicalThere is no need for a gastrostomy in this technique.↗
▶Ep 6 · 4:00
clinicalThe patient remains intubated in the intensive care unit on parenteral nutrition between stages.↗
▶Ep 6 · 4:10
clinicalChest drainage is not used in this technique.↗
▶Ep 6 · 4:20
opinionThe presenter prefers intermittent suction on demand rather than continuous suction with a Replogle tube, as continuous suction dries the mucosa.↗
▶Ep 6 · 4:20
quoteI am personally against suction with the repro tube, as it dries the mucosa, in my opinion. I prefer intermittent suction on demand.↗
▶Ep 6 · 4:40
quoteAnastomosis is possible if both ends overlap, but care must be taken when deciding. There is no way back. Any failure will result in the loss of part of the esophagus.↗
▶Ep 6 · 4:40
clinicalAnastomosis is possible if both ends overlap, but care must be taken when deciding as there is no way back and any failure will result in the loss of part of the esophagus.↗
▶Ep 6 · 5:00
clinicalAn 8 French nasogastric tube is passed down into the stomach after pouches opening.↗
▶Ep 6 · 5:10
clinicalTraction must be maintained until the first sutures are placed, because both esophageal pouches can easily retract, making anastomosis very difficult.↗
▶Ep 6 · 5:35
clinicalThe thoracoscopic internal traction technique was used in 25 cases of long gap esophageal atresia and completed with anastomosis in 23 cases.↗
▶Ep 6 · 5:50
clinicalMost cases were completed in 2 stages, but there were also 2 cases operated on in 5 and 6 stages.↗
▶Ep 6 · 6:05
clinicalInitially, the time between stages was about 4 weeks, but this was reduced to a few days.↗
▶Ep 6 · 6:12
opinionWhen both ends overlap each other, anastomosis can be started, but if there is any tension even with overlap, the presenter would connect them with one suture and wait 2 or 3 days more before proceeding.↗
▶Ep 6 · 6:20
clinicalIn the last series of 9 primary cases without gastrostomy, the average hospital stay was 31 days.↗
▶Ep 6 · 6:35
clinicalOne gastric pull-up complication occurred and was later successfully treated laparoscopically.↗
▶Ep 6 · 7:28
opinionThe presenter strictly defines long gap as only type A and B esophageal atresia, not type C.↗
▶Ep 6 · 7:28
quoteI am very strict about the definition of long gap. OK. Long gap, it's just only type A and B. It's my definition, of course, many people agree with them because if you say that type C is a long gap, it's quite a different story.↗
▶Ep 6 · 7:57
clinicalIn the presenter's experience, type C esophageal atresia was always possible to make primary anastomosis, with the only exception being when the patient was unstable.↗
▶Ep 6 · 9:00
clinicalIf the sliding knot needs adjustment in subsequent procedures, the same sliding knots can be unlocked and reused rather than placing new sutures.↗
▶Ep 6 · 9:00
quoteYou just open it. If you are very familiar with the sliding note, yeah, you locked it, blocked it, then you can reopen it. So I use the same, OK, I use every time I entered the chest again, I use the same sliding notes. You unlock it.↗
▶Ep 6 · 9:21
clinicalTo unlock a sliding knot, one end is a little bit longer and the other end is a little bit shorter; the long one is pulled to unlock it.↗
▶Ep 6 · 9:50
quoteThat's my quotation, that sliding knot changed my surgical life.↗
Overall Winner: Dariusz Patkowski, MD - Best of the Best in Pediatric Surgery 2024
▶Ep 7 · 3:15
quoteThank you so much. Thank you, very, uh, really. Uh, I didn't suppose that it is possible. So, thank you, thank you very much. I'm very happy that this technique. Uh, was awarded with such a, a great audience.↗
