gms | German Medical Science

Background: Esophageal atresia (EA) is a common malformation in Pediatric Surgery. In recent years we have adopted two tecnique surgical approaches to our treatment and would like to share our experiences with them.

Materials and methods: Within the years 2010 and 2015 we treated 21 patients with EA in our Department of Pediatric Surgery at the University Medical Center Dresden. In 16 cases we found a Vogt type IIIb lesion, in five cases the patients were diagnosed with Vogt type II EA (24%).

Patients with type IIIb EA were operated on within the first and eighth day of life, except for one child with a VACTERL association, where the procedure was caried out on the twentieth day after birth. In all cases a primary anastomosis could be performed. The two most recent patients were treated by a thoracoscopic approach, which we had not done before in our clinic.

The five patients with a Vogt type II long gap EA were born 31. and 34. week of gestation and received a gastrostomy for enteral feeding within the first two days of life. All of these patients presented with associated malformations. In one of the patients, primary anastomosis was done in the 15. week of life. The other four patients underwent thoracotomy between the 9. and 20 week of life.

Results: Operating times in the thoracoscopic approaches were around 170 minutes and a primary anastomosis was performed. Besides the preservation of the thorax using this approach we also found the preservation of the vena azygos, that did not have to be ligated, to be an advantage of the method. There were no major complications in the series of Vogt type IIIB EA. Eleven of the 16 patients (69%) did not need dilatation of the anastomotic region at all, in four cases two to four dilatations were performed and in only case of a patient with a VACTERL association there was a relevant stenosis of the anastomotic region.

In all cases of EA Vogt type II a primary anastomosis could not be carried out and traction sutures were applied to both esophageal pouches (Foker procedure). In three cases a secondary anastomosis could be performed four to six weeks into the traction procedure. In one case of a patient with trisomy 21 however the sutures tore after eight days of traction and leakage of the upper esophageal pouch led to a thorax effusion. A collar fistula was made until the local inflammation settled and interposition of a gastric tube could be performed in the 28. week of life. This is the only patient, that still cannot be fed orally although the necessary pathway has been established. In the other four patients, dalatation of the anastomosis needed to be performed regularly while they are fully orally fed.

Conclusion: I conclude that we have successfully introduced two previously not in our Clinic applied surgical tecniques to our repertoire for treating patients with EA. We find the thoracoscopic approach recommendable for treating short gap esophageal atresia as it spares the thorax wall and azygos vein and it is feasible to carry out by a surgeon experienced in endoscopic surgery.

In long gap EA we successfully treated three patients with the Foker procedure without complications, while in one case the procedure had to be abandonded due to complications. Given the known challenge of treating long gap esophageal atresia ideally, we find the Foker procedure to be a useful tool still leaving the option of a gastric tube interposition in case of failure.