Thoracoscopic correction of esophageal atresia in children in Dagestan



Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

   Introduction. The authors share their experience in treating children with esophageal atresia (EA) using the thoracoscopic technique.
   Material and methods. 25 children with EA were operated on in N. M. Kuraev Children’s Republican Clinical Hospital in Makhachkala (Republic of Dagestan, Russia) in 2020–2022. 17 children had thoracoscopy; 13 were put primary anastomosis of the esophagus; 3 had gastrostomy after ligation of the tracheoesophageal fistula; in one child, who had no EA fistula, surgeons
put internal traction sutures on the proximal and distal ends of the esophagus without gastrostomy. Of 13 patients with primary anastomosis of the esophagus, 3 had conversion; in one patient without EA fistula, thoracoscopic esophageal anastomosis was put on the 6th day after internal traction sutures. Thus, the authors have analyzed outcomes in 10 patients with primary anastomoses and in one patient with delayed one who were operated on with the thoracoscopic technique.
   Results. Outcomes of treating children with EA after putting thoracoscopic anastomoses of the esophagus were evaluated.
   Discussion. On analyzing literature data on EA thoracoscopic correction, one can see good cosmetic effects at early and especially at late postoperative periods with low incidence of musculoskeletal deformity. A serious problem for most pediatric surgeons is the impossibility to create primary anastomoses in the neonatal period. In our case, the only obstacle was a large diastasis between segments of the esophagus. Yu. Yu. Kozlov et al. reported about a new approach applied in two newborns with EA: thoracoscopic traction elongation of the esophagus can be made without gastrostomy followed by esophago-esophagoanastomosis on days 5 and 6, respectively. They observed only stenosis of the anastomosis in both cases, what we also observed in one case.
   Conclusion. Thoracoscopic technique for esophago-esophagoanastomosis is less traumatic; it improves visualization of the surgical field, gives good cosmetic results and does not cause rough cicatricial changes and musculoskeletal deformities.

About the authors

B. M. Makhachev

Dagestan State Medical University; N. M. Kuraev Children’s Republican Clinical Hospital

Email: fake@neicon.ru

367000

367027

Makhachkala

Россия

S. A. Gebekova

Dagestan State Medical University; N. M. Kuraev Children’s Republican Clinical Hospital

Author for correspondence.
Email: safffrat@mail.ru

Safat A. Gebekova, MD, PhD, head of department, Assistant

367000

367027

department of planned surgery

Makhachkala

Россия

F. V. Meylanova

Dagestan State Medical University

Email: fake@neicon.ru

367000

Makhachkala

Россия

A. N. Tikhmaev

Dagestan State Medical University; N. M. Kuraev Children’s Republican Clinical Hospital

Email: fake@neicon.ru

367000

367027

Makhachkala

Россия

V. T. Ashurbekov

Dagestan State Medical University

Email: fake@neicon.ru

367000

Makhachkala

Россия

A. S. Saidmagomedova

Dagestan State Medical University

Email: fake@neicon.ru

367000

Makhachkala

Россия

References

  1. Gibson T. The anatomy of humane bodies epitomized. Wherein all the parts of man's body, with their actions and uses, are succinctly described, according to the newest doctrine of the most accurate and learned modern anatomists. The sixth edition, corrected and improved, both in th discourse and figures. London: printed by T. W. for Awnsham and John Churchill, at the Black Swan in Pater-Noster-Row, 1703.
  2. Ladd W. E. The surgical treatment of esophageal atresia and tracheoesophageal fistula. N Engl J Med. 1944; 230–625.
  3. Leven N. L. Congenital atresia of the esophagus with tracheoesophageal fistula: Report of successful extrapleural ligation of fistulous communication and cervical esophagostomy. J. Thorac. Surg. 1940; 10: 648.
  4. Пури П. Атрезия пищевода / П. Пури, М. Гольварт. – В кн.: Атлас детской оперативной хирургии. – М.: МЕДпресс-информ, 2009. – 43–62. – Puri P., Golvart M. Esophageal atresia. In: Atlas of Pediatric operative Surgery [Atlas detskoj operativnoj hirurgii]. Moscow: MEDpress-inform, 2009; 43–62. (in Russian)
  5. Haight C., Towsley H. A. Congenital atresia of the esophagus with tracheoesophageal fistula; extrapleural ligation of fistula and end-to-end anastomosis of esophageal segments. Surg. Gynecol. Obstet. 1943; 76: 672.
  6. Pinheiro P. F., Simoes e Silva A. C., Pereira R. M. Current knowledge on esophageal atresia. World J. Gastroenterol. 2012; 18 (28): 3662–72.
  7. Баиров В. Г. Повторные операции у детей с атрезией пищевода / В. Г. Баиров. – СПб., 1998. – 188 с. – Bairov G. A. Repeated operations in children with esophageal atresia [Povtornye operacii u detej s atreziej pishchevoda]. Saint-Petersburg, 1998; 188 pp. (in Russian)
  8. Баиров Г. А. Атлас операций у новорождённых / Г. А. Баиров, Ю. Л. Дорошевский, Т. К. Немилова. – М.: Медицина, 1984. – 251. Bairov G. A., Doroshevskij Yu. L., Nemilova T. K. Atlas of operations in newborns [Atlas operacij u novorozhdennykh]. Moscow: Medicina, 1984; 251. (in Russian)
  9. Lobe T. E., Rothenberg S. S., Waldschmidt J. Thoracoscopic repair of esophageal atresia in an infant: A surgical first. Pediatr Endosurg Innovative Tech. 1999; 3: 141–8.
  10. Rothenberg S. S. Thoracoscopic repair of a tracheoesophageal fistula in a newborn infant. Pediatr. Endosurg. Innov. Tech. 2004; 289–94.
  11. Козлов Ю. А. Атрезия пищевода – торакоскопическое наложение анастомоза / Ю, А. Козлов [и др.] // Детская хирургия. – 2005. – 3: 54. – Kozlov Yu. A., Yurkov P. S., Novozhilov V. A. et al. Esophageal atresia – thoracoscopic anastomosis. Detskaya khirurgiya. 2005: 3: 54. (in Russian)
  12. Разумовский А. Ю. Торакоскопическая коррекция атрезии пищевода: первый этап / А. Ю, Разумовский [и др.] // Детская хирургия. – 2010. – 3: 4–8. – Razumovskij A. Yu., Geraskin A. V., Mokrushina O. G., Belyaeva I. D., Golodenko N. V., Everstova T. N., Mitupov Z. B., Hanverdiev R. A., Koshko O. V., Geodakyan O. S., Kuleshov B. V. Thoracoscopic correction of esophageal atresia: the first stage. Detskaya khirurgiya. 2010; 3: 4–8. (in Russian)
  13. Разумовский А. Ю. Непосредственные результаты торакоскопической коррекции атрезии пищевода у новорождённых / А. Ю. Разумовский [и др.] // Детская хирургия. – 2011. – 4: 4–9. Razumovskij A. Yu., Hanverdiev R. A. Immediate results of thoracoscopic correction of esophageal atresia in newborns. Detskaya khirurgiya. 2011; 4: 4–9. (in Russian)
  14. Chang E. Y., Chang H. K., Han S. J., Choi S. H., Hwang E. H., Oh J. T. Clinical characteristics and treatment of esophageal atresia: a single institutional experience. J. Korean Surg. Soc. 2012; 83 (1): 43–9.
  15. Conforti A., Morini F., Bagolan P. Difficult esophageal atresia: Trick and trea. Seminars in Pediatric Surgery. 2014; 23 (5): 261–9.
  16. Koivusalo A., Pakarinem M., Rintala R. Modern outcomes of esophageal atresia: single centre experience over the last twenty years. J Pediatr Surg. 2013; 48: 297–303.
  17. Holcomb G. W., 3rd, Rothenberg S. S., Bax K. M., Martinez-Ferro M., Albanese C. T., Ostlie D. J., van Der Zee D. C., Yeung C. K. Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula: a multi-institutional analysis. Ann Surg. 2005; 242: 422–8.
  18. Козлов Ю. А. Торакоскопическое лечение детей с атрезией пищевода / Ю. А. Козлов [и др.] // Российский вестник детской хирургии, анестезиологии и реаниматологии. – 2017. – 7 (3): 14–24. – Kozlov Yu. A., Novozhilov V. A., Rasputin A. A., Baradieva P. Zh., Zvonkov D. A., Timofeev A. D., Ochirov Ch. B., Rasputina N. V., Us G. P., Kuznecova N. N. Thoracoscopic treatment of children with esophageal atresia. Rossijskij vestnik detskoj khirurgii, anesteziologii i reanimatologii. 2017; 7 (3): 14–24. (in Russian)
  19. Lowal T., Gosemann J., Kuebler J., Gluer S., Ure B. M. Thoracoscopy versus thoracotomy improves midterm musculoskeletal status and cosmesis in infants and children. Ann Thorac Surg. 2009; 87: 224–8.
  20. Красовская Т. В. Хирургическая тактика при различных формах атрезии пищевода / Т. В. Красовская [и др.] // Детская хирургия. – 2000. – 5: 46–50. – Krasovskaya T. V., Kucherov Yu. I., Bataev H. M., Tolstov K. N., Mokrushina O. G. Surgical tactics for various forms of esophageal atresia. Detskaya khirurgiya. 2000; 5: 46–50. (in Russian)
  21. Conforti A., Morini F., Bagolan P. Difficult esophageal atresia: Trick and treat. Seminars in Pediatric Surgery. 2014; 23 (5): 261–9. https://doi.org/10.1053/j.sempedsurg.2014.09.006
  22. Chang E. Y., Chang H. K., Han S. J., Choi S. H., Hwang E. H., Oh J. T. Clinical characteristics and treatment of esophageal atresia: a single institutional experience. J. Korean Surg. Soc. 2012; 83 (1): 43–9.
  23. Sawicka E., Zak K., Boczar M., Ploska-Urbanek B., Mydlak D., Woynarowska M. Surgical treatment of neonates with very low or extremely low birth weight. Med. Wieku Rozwoj. 2011; 15 (3 Pt 2): 394–405.
  24. Nasr A., Langer J. C. Mechanical traction techniques for long-gap esophageal atresia: a critical appraisa. Eur. J. Pediatr. Surg. 2013; 23 (3): 191–7.
  25. Бревдо Ф. Ф. Отсроченный анастомоз при атрезии пищевода / Ф. Ф. Бревдо, Ю. Ф. Бревдо // Детская хирургия. – 2003. – 6: 54–5. – Brevdo F. F., Brevdo Yu. F. Delayed anastomosis in esophageal atresia. Detskaya khirurgiya. 2003; 6: 54–5. (in Russian)
  26. Huh Y. J., Kim H. Y., Lee S. C., Park K. W., Jung S. E. Comparison of outcomes according to the operation for type A esophageal atresia. Ann. Surg. Treat. Res. 2014; 86 (2): 83–90.
  27. Hunter C. J., Petrosyan M., Connelly M. E., Ford H. R., Nguyen N. X. Repair of long-gap esophageal atresia: gastric conduits may improve outcome-a 20-year single center experience. Pediatr. Surg. Int. 2009; 25 (12): 1087–91.
  28. Ito K., Ashizuka S., Kurobe M., Ohashi S., Kuwashima N., Yoshizawa J., Ohki T. Delayed primary reconstruction of esophageal atresia and distal tracheoesophageal fistula in a 471-g infant. Int. J. Surg. Case Rep. 2013; 4 (2): 167–9.
  29. Lee H. Q., Hawley A., Doak J., Nightingale M. G., Hutson J. M. Long-gap esophageal atresia: comparison of delayed primary anastomosis and Oesophageal replacement with gastric tube. J. Pediatr. Surg. 2014; 49 (12): 1762–6.
  30. Charlesworth P., Mahomed A. A radiological cronicle of the presentation and management of a long gap oesophageal atresia. J. Radiol. Case Rep. 2009; 3 (7): 17–21.
  31. Teague W. J., Karpelowsky J. Surgical management of oesophageal atresia. Paediatr Respir Rev. 2016; 19: 10–5.
  32. Красовская Т. В. Осложнения оперативного лечения атрезии пищевода / Т. В. Красовская [и др.] // Детская хирургия. – 2001. – 3: 44–7. – Krasovskaya T. V., Kucherov Yu. I., Bataev S.-H. M., Tolstov K. N., Mokrushina O. G. Complications of surgical treatment of esophageal atresia. Detskaya khirurgiya. 2001; 3: 44–7. (in Russian)
  33. Livaditis A. Esophageal atresia: A method of overbridging large segmental gaps. Z. Kinderchir. 1973; 13: 298–306.
  34. Gough M. N. Esophageal atresia-use of an anterior flap in difficult anastomosis. J. Pediatr. Surg. 1980; 15 (3): 310–1.
  35. Howard R., Myers N. A. Esophageal atresia: A technique for elongating the upper pouch. Surg. 1965; 58: 725–7.
  36. Nasr A., Langer J. C. Mechanical traction techniques for long-gap esophageal atresia: a critical appraisal. Eur. J. Pediatr. Surg. 2013; 23 (3): 191–7.
  37. Sroka M., Wachowiak R., Losin M., Szlagatus-Sidorkiewicz A., Landowski P., Czauderna P., Foker J., Till H. The Foker technique and Kimura advancement for the treatment of children with long-gap esophageal atresia: lessons learned at two European centers. Eur. J. Pediatr. Surg. 2013; 23 (1): 3–7.
  38. Takamizawa S., Nishijima E., Tsugawa C., Muraji T., Satoh S., Tatekawa Y., Kimura K. Multistaged esophageal elongation technique for long gap esophageal atresia: experience with 7 cases at a single institution. J. Pediatr. Surg. 2005; 40: 781–4.
  39. Tamburri N., Laje P., Boglione M., Martinez-Ferro M. Extrathoracic esophageal elongation (Kimura,s technique): a feasible option for the treatment of patients with complex esophageal atresia. J. Pediatr. Surg. 2009; 44: 2420–5.
  40. Foker J. E., Kendall Krosch T. C., Catton K., Munro F., Khan K. M. Long-gap esophageal atresia treated by growth induction: the biological potential and early follow-up results. Semin. Pediatr. Surg. 2009; 18 (1): 23–9.
  41. Hadidi A. T., Hosie S., Waag K. L. Long gap esophageal atresia: lengthening technique and primary anastomosis. J. Pediatr. Surg. 2007; 42: 1659–62.
  42. Tanaka Y., Uchida H., Kawashima H., Sato K., Takazawa S., Jimbo T., Iwanaka T. Successful two-stage thoracoscopic repair of long-gap esophageal atresia using simple internal traction and delayed primary anastomosis in a neonate: report of a case. Surg. Today. 2013; 43 (8): 906–9.
  43. Van der Zee D. K., Gallo G., Tytgat S. H. Thoracoscopic traction technique in long gap esophageal atresia: entering a new era. Surg. Endosc. 2015; 29 (11): 3324–30.
  44. Bairdain S., Hamilton T. E., Smithers C. J., Manfredi M., Ngo P., Gallagher D., Zurakowski D., Foker J. E., Jennings R. W. Foker process for the correction of long gap esophageal atresia: Primary treatment versussecondary treatment after prior esophageal surgery. J Pediatr Surg. 2015; 50 (6): 933–7.
  45. Alberti D., Boroni G., Corasaniti L., Torri F. Esophageal atresia: pre and post-operative management. J. Matern Fetal Neonatal Med. 2011; 24 (1): 4–6.
  46. Sri Paran T., Decaluwe D., Corbally M., Puri P. Long-term results of delayed primary anastomosis for pure oesophageal atresia: a 27-year follow up. Pediatr. Surg. Int. 2007; 23 (7): 647–51.
  47. Zani A., Eaton S., Hoellwarth M. E., Puri P., Tovar J., Fasching G., Bagolan P., Lukac M., Wijnen R., Kuebler J. F., Cecchetto G., Rintala R., Pierro A. International survey on the management of esophageal atresia. Eur. J. Pediatr. Surg. 2014; 24 (1): 3–8.
  48. Козлов Ю. А. Этапное торакоскопическое лечение атрезии пищевода с большим диастазом без использования гастростомии / Ю. А. Козлов [и др.] // Российский вестник детской хирургии, анестезиологии и реаниматологии. – 2019/ – 9 (4): 43–9. – Yury A. Kozlov, Andrey A. Rasputin, Polina Jh. Baradieva, Chimit B. Ochirov, Vladislav S. Cheremnov. Staged thoracoscopic treatment of long-gap esophageal atresia without the need for a gastrostomy. Rossijskij vestnik detskoj hirurgii, anesteziologii i reanimatologii (Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care). 2019; 9 (4): 43–9. https://doi.org/10.30946/2219-4061-2019-9-4-43-49 (in Russian)
  49. Friedmacher F., Puri P. Delayed primary anastomosis for management of long-gap esophageal atresia: a metaanalysis of complications and long-term outcome. Pediatr. Surg. Int. 2012; 28 (9): 899–906.

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c)

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies