What Proportion of Children With Complex Oesophageal Atresia (OA) Require Oesophageal Lengthening Procedures? | Consecutive series review | Newcastle, UK | 1998-2023 | 207 children born with esophageal atresia | 25/29 complex atresia patients reviewed | Surgical Outcomes non-lengthening vs. lengthening | RESULTS | 78% native esophagus retention non-lengthening | ZERO operative mortality in non-lengthening | Salvage surgery needed in - | 9% non traction/non lengthening | 3/4 with lengthening | Overall outcomes | Conclusion: Study suggests there may be minimal need for esophageal lengthening procedures in complex OA patients | https://doi.org/10.1016/j.jpedsurg.2023.10.014 | SOURCE: Philips L et al. The Great North Children's Hospital | @StayCurrent MD | @kim_p_rn | Cincinnati Children's | Journal of Pediatric Surgery
What Proportion of Children With Complex Oesophageal Atresia Require Oesophageal Lengthening Procedures?
Infographic · May 2024 · 1 min read
In brief
In brief
This UK single-center study of 215 esophageal atresia cases found that only 2% required lengthening procedures, with 97% retaining native esophagus through delayed primary anastomosis or replacement. The findings challenge routine use of traction techniques in complex cases, demonstrating comparable outcomes with lower morbidity.
- Only 2% of oesophageal atresia cases actually required lengthening procedures; 97% retained native oesophagus without lengthening.
- Delayed primary anastomosis without lengthening achieved 78% native oesophagus retention in complex OA with lower morbidity.
- Traction techniques led to salvage oesophageal replacement in 2 cases, questioning routine use of lengthening procedures.
- Complex OA managed without lengthening had zero in-hospital mortality and outcomes identical to non-complex cases.
- Median 77 days to oesophageal continuity in complex OA treated conservatively suggests watchful waiting is viable.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with anatomical illustrations of an infant's head/neck showing esophageal anatomy. The layout flows from top to bottom with study details, key statistics highlighted in red numbers, results section with bullet points, and a yellow conclusion box on the right. Medical illustrations and institutional logos appear at the bottom.
New infographic by Kim Priban from Journal of Pediatric Surgery
"What Proportion of Children With Complex Oesophageal Atresia Require Oesophageal Lengthening Procedures?"
Authors: Laura Phillips, Bruce Jaffray
Full article:
Background
Babies with oesophageal atresia (OA) who cannot achieve a primary anastomosis (complex OA) may be treated by attempted oesophageal lengthening. We contrast reported outcomes of lengthening with our experience of managing complex OA.
Methods
A consecutive series treated in an English regional centre was completed. Outcomes of interest were the rate of retention of the native oesophagus, complications requiring thoracotomy, rates of anastomotic leak, stricture, fundoplication, and mortality. Possible explanatory variables were the surgical techniques applied.
Results
29/215 (13%) OA were complex, and 25/207 survived to repair. 14/25 (56%) had no distal fistula, pure OA, while 11/25 (44%) had a long gap with distal fistula. 18/25 (72%) had delayed primary anastomosis, while 7/25 (28%) required oesophageal replacement. However, 2 of the replacements were salvage procedures following failed traction. Only 4/207 (2%) of OA were potentially treatable by traction. Salvage surgery was required in 2/23 (9%) complex OA not subjected to lengthening. The native oesophagus was retained without utilising lengthening in 200/207 (97%). Amongst complex OA where traction techniques had not been attempted, the native oesophagus was retained in 18/23 (78%) of cases, with median time to oesophageal continuity of 77 days. There was no in hospital mortality following treatment of complex OA, and overall survival was identical to non-complex OA among cases surviving to anastomosis.
Conclusion
Management of complex OA without lengthening procedures leads a similar rate of retention of the native oesophagus as reports describing lengthening, but with significantly less morbidity. We see little need for oesophageal lengthening in the management of complex OA.