What Proportion of Children With Complex Oesophageal Atresia Require Oesophageal Lengthening Procedures?
Timestops (5)
Tools Used
Topic Overview
New article you should know from the Journal of Pediatric Surgery, Summarized by Kim Priban RN
Made possible by @cincychildrens#SoMe4PedSurg
Full Article- "What Proportion of Children With Complex Oesophageal Atresia Require Oesophageal Lengthening Procedures?" Phillips L et al.
Link-
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.
Keywords
Hashtags
Transcript
Do pediatric patients with complex esophageal resia really need to have an esophageal lengthening procedure, and does it lead to better outcomes when they do? Hi, I'm Kim Pribben, a research fellow at Cincinnati Children's, and this is an article worth knowing about. This was a consecutive series study out of the UK that focused on operative outcomes of 25 pedia. Pediatric patients with complex atresia who underwent surgical repair. The study compared the outcomes of 23 patients who had non-lengthening procedures and 2 who had a lengthening procedure. What do you think the findings were? Of the 25 surgically repaired complex atresias, 7 total patients went on to require an esophageal replacement. 100% of the 2 patients who had the lengthening traction in this study required oesophageal replacement, and only 5 of the non-lengthening. When measuring anastomotic leak, stricture, and salvage surgery, there is not a significant difference between the two techniques. This study shows us that we really need to weigh the risk versus the benefit of a lengthening procedure in babies with complex oesophageal atresia, because the non-lengthening procedure may be a safer option with similar outcomes. Thank you for watching, like and share, and check back often for more articles we think you should know about.