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Esophageal elongation by bougienage and delayed primary thoracoscopic anastomosis for pure esophageal atresia without tracheoesophageal fistula

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Abstract

Purpose

We aim to share our experience of esophageal elongation by bougienage and delayed primary thoracoscopic anastomosis for pure esophageal atresia (EA) without tracheoesophageal fistula (TEF).

Methods

Fifteen patients with pure EA treated with delayed primary thoracoscopic anastomosis combined with or without esophageal elongation by bougienage were retrospectively analyzed.

Results

Four patients were managed without bougienage, and their surgical repair was performed thoracoscopically after natural esophageal growth. Among the remaining 11 patients, the average tension-free distance before elongation was 5 (4.5–6) vertebral bodies, and the mean age at the start and end of the bougienage period was 123 (63–280) days and 173 (106–350) days, respectively, with an average duration of 50 (29–82) days. The average age at the definitive operation in this series was 184 (107–385) days, with a mean operative duration of 186 (95–300) min. Neither anastomotic leakage nor TEF occurred, and oral feeding was partially or completely established in 13 patients during hospitalization. Among all patients, one was lost to follow-up, and others were followed up with an average duration of 47.7 (9.8–97.1) months. All patients had different degrees of anastomosis stricture, and 8 patients had gastroesophageal reflux. Oral feeding was completely established in 12 patients; however, tube feeding was required in 2 patients.

Conclusions

The management of pure EA is complicated and inconclusive. Esophageal elongation by bougienage and delayed primary thoracoscopic anastomosis for long-gap pure EA without TEF is safe and effective.

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Acknowledgements

We are grateful to the patients and their family members who participated in this study. In addition, we thank Wu Dan for providing language help.

Funding

This work was supported by the Beijing Municipal Science & Technology Commission (Z211100002921062) and The Key Research and Development Program of Jiangxi Province (20203BBGL73186).

Author information

Author notes

  1. Kaiyun Hua and Shen Yang contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Neonatal Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, China

    Kaiyun Hua, Shen Yang, Yong Zhao, Yanan Zhang, Yichao Gu, Junmin Liao, Shuangshuang Li, Dingding Wang & Jinshi Huang

  2. Department of Neonatal Surgery, The Affiliated Children’s Hospital of Nanchang University, Nanchang, 330006, China

    Wei Fan, Zhi Yang & Jinshi Huang

Authors
  1. Kaiyun Hua
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  2. Shen Yang
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  3. Wei Fan
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  4. Zhi Yang
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  11. Jinshi Huang
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Contributions

Study conception and design: JH, KH, SY. Data acquisition: WF, ZY, YZ, YZ, YG. Analysis and data interpretation: JL, SL, DW. Drafting of the manuscript: KH, SY. Critical revision: JH, KH, SY.

Corresponding author

Correspondence to Jinshi Huang.

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Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). This retrospective study was approved by the Medical Ethics Committee of Beijing Children’s Hospital (2019-k-333).

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The patient informed consent requirements were waived.

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Hua, K., Yang, S., Fan, W. et al. Esophageal elongation by bougienage and delayed primary thoracoscopic anastomosis for pure esophageal atresia without tracheoesophageal fistula. Pediatr Surg Int 38, 1005–1012 (2022). https://doi.org/10.1007/s00383-022-05138-7

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  • DOI: https://doi.org/10.1007/s00383-022-05138-7

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