Long-gap oesophageal atresia: comparison of delayed primary anastomosis and oesophageal replacement with gastric tube.
J Pediatr Surg
; 49(12): 1762-6, 2014 Dec.
Article
in En
| MEDLINE
| ID: mdl-25487479
ABSTRACT
BACKGROUND:
Long-gap oesophageal atresia (LGOA) causes significant early and long-term morbidity. We conducted a retrospective 25-year review comparing outcomes of delayed primary anastomosis versus oesophageal replacement with greater curvature gastric tube.METHODS:
Records of 44 consecutive patients undergoing LGOA repair (1986-2010) were obtained from OA database with ethics approval and were analysed for complication and long-term outcomes. Analysis was conducted using Student's t-test for quantitative and Fisher exact test for qualitative data.RESULTS:
Thirty (68%) patients underwent delayed primary anastomosis and 14 (32%) had oesophageal replacement. Oesophageal replacement patients had longer gaps (mean 5.5 vertebrae, range 4-9) compared to delayed primary anastomosis (mean 3.9, range 2-6) (p=0.004), but no difference in perioperative complications (p=0.2) (Table 1). Oesophageal replacement had more long-term complications (86%) compared to delayed primary anastomosis (30%) (p=0.005). Almost all patients (>90%) experienced gastro-oesophageal reflux and 21 delayed primary anastomosis patients (70%) underwent fundoplication. 60% of delayed primary anastomosis and 64.3% of oesophageal replacement patients had continued gastrointestinal symptoms years after repair.CONCLUSIONS:
Our experience indicates that LGOA can be repaired safely using both methods, with no deaths and similar perioperative risk, but high long-term morbidity mandates long-term follow-up of these patients. Delayed primary anastomosis has a better long-term outcome compared to oesophageal replacement with gastric tube.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Stomach
/
Gastroplasty
/
Enteral Nutrition
/
Esophageal Atresia
/
Esophagoplasty
/
Esophagus
/
Forecasting
Type of study:
Observational_studies
/
Prognostic_studies
/
Qualitative_research
/
Risk_factors_studies
Aspects:
Ethics
Limits:
Adolescent
/
Adult
/
Child
/
Child, preschool
/
Female
/
Humans
/
Infant
/
Male
/
Newborn
Language:
En
Journal:
J Pediatr Surg
Year:
2014
Document type:
Article
Affiliation country: