Comparison of delayed primary esophageal repair in patients with long gap esophageal atresia with neonatal esophageal replacement by gastric pull up sugery

Abstract

The aim of this study was to evaluate the results of delayed esophageal repair as primary anastomosis with neonatal esophageal replacement by gastric pull up in treatment of long gap esophageal atresia. Patients/Methods: In this study, 25 patients with long gap esophageal atresia (type A) were randomly divided into two study groups. The first group (14 patients) underwent tube gastrostomy in infancy for entral feeding and intermittent suction of the upper esophageal secretions. The gap between the upper and lower esophageal pouch was measured in the gastrostomy surgery and then at 20-day intervals and when it reached at least 2 vertebrae bodies the primary repair was performed by thoracotomy. The success rate of the treatment method in maintaining the patient's esophagus and the occurrence of complications during the pre-operation, peri-operation and post operation periods were recorde and patient followed for at least 6 months. The second group (11 patients) underwent esophageal replacement by gastric pull up in neonatal period, after the stabilization of clinical conditions, and the mortality, success rate and complications were similarly recorded and compared with the first group. Results: The reduction in the distance between the proximal and distal esophagus pouch during the waiting period was significant and as a result, the success rate of maintaining the patient's esophagus in the delayed surgery group was 85.71% (12 Patients). No mortality observed during peri operative and postoperative period in this group. Neonatal gastric transpostion was successful in all patients in the second group, but neonatal mortality in the postoperative period was 36.36% (4 patient), two due to neonatal sepsis and two of severe distress and cardio pulmunary failure. During the follow-up period, anastomotic site stenosis and gastroesophageal reflux were the most common complications in both treatment groups. The incidence of stenosis in the first group was significantly higher than the second group (P =). Dilatation was often successful, and revision surgery to resect the stenosis required in only one case.