Endoscopic esophageal substitution for pure esophageal atresia and wide gap esophageal atresia: A report of five cases with minimum follow-up of twelve months

Sujit K. Chowdhary*, Deepak K. Kandpal, Deepak Agarwal, Saroja Balan, Nameet Jerath, Anupam Sibal, Sohan L. Broor

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Aim The aim of the study is to report feasibility and safety of endoscopic esophageal substitution in infants with pure esophageal atresia and wide gap tracheoesophageal fistula with a minimum one year follow-up. Materials and methods This prospective study was conducted from January 2012 for twenty four consecutive months at Apollo Hospital, New Delhi. All babies either followed up or referred for esophageal substitution without any history of mediastinitis or associated major congenital anomaly and weighing greater than 6 kg were to be included in the study. The indication, intraoperative details, operative approach, conversion to open, esophageal substitute, postoperative ventilation, ICU and hospital stay, time to solid foods, morbidity and mortality were recorded. Informed consent was obtained from all the parents and ethical clearance was obtained for the study from the hospital ethical committee. Postoperatively babies were followed up monthly for first six months, 3 monthly for next six months and annually thereafter. Results Between January 2012 and December 2013, in the two year period six infants were admitted for laparoscopic gastric transposition. In five patients the procedure was completed by the laparoscopic approach and one required conversion to open surgery owing to dense adhesions. The age range at the time of surgery was from 8 months to 12 months with a mean age of 10 months. Four patients had pure esophageal atresia (type A) and two had wide gap esophageal atresia with distal tracheoesophageal atresia (type C). Five had primary esophagostomy and gastrostomy as a newborn, the sixth had postoperative anastomotic leak and required subsequent diversion. The mean operating time was 194 minutes (range 170-210 minutes). The mean stay in ICU was 7 days with a range of 4-12 days. All patients were ventilated in the postoperative period for an average of 5 days with a range of 4-7 days. One patient had prolonged gastric ileus which delayed the oral feeds by 14 days. The mean time to start the oral feeds was 8 days with a range of 6-14 days. The mean hospital stay was 19.6 days (range 16-23 days). Early complications were pneumonia and pleural effusion in one patient. One patient developed anastomotic stricture which was amenable to dilatation. One patient had leak from esophagogastric anastomosis which healed spontaneously. All children are now orally fed, swallow without difficulty, and parents report an excellent cosmetic outcome. The follow-up ranges from 12 to 36 months. Conclusion The initial results of endoscopic esophageal substitution are encouraging and easily comparable to the outcome of open surgery with all the attendant benefits of minimally invasive approach.

Original languageEnglish
Pages (from-to)360-363
Number of pages4
JournalJournal of Pediatric Surgery
Volume51
Issue number3
DOIs
Publication statusPublished - 1 Mar 2016
Externally publishedYes

Keywords

  • Endoscopic
  • esophageal atresia
  • esophageal substitution
  • pure esophageal atresia
  • wide gap

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