Thoracoscopic assisted colon interposition for long-gap esophageal atresia: a novel technique
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Thoracoscopic assisted colon interposition for long‑gap esophageal atresia: a novel technique Elisa Pani1 · Enrico Ciardini2 · Elisa Severi1 · Noemi Cantone1 · Francesca Tocchioni1 · Nicola Centonze1 · Bruno Noccioli1 Received: 26 September 2019 / Revised: 7 May 2020 / Accepted: 9 May 2020 © Springer Nature Singapore Pte Ltd 2020
Abstract Purpose The purpose of this work is to present preliminary results of a novel technique of thoracoscopically assisted colon interposition for esophageal replacement in long-gap esophageal atresia (LGEA). Methods Management of LGEA remains a challenge. When primary repair is not possible, esophagocoloplasty is our first choice for esophageal replacement; we usually place the colon retrosternally, but we treated two patients with LGEA who had previously undergone a sternotomy. Therefore, we decided to place the graft via an intrathoracic route, but the passage of the colic graft into the thorax was performed video-assisted thoracoscopic. Results The follow-up of the two patients is now 4 years. They are both currently in good general conditions and their feeding behavior is comparable to the other infants of equal in age. We have not got any complications related to the technique, in particular any problems associated with the thoracoscopically assisted colonic replacement. Conclusion We found that short-term survival was accomplished with apparently equivalent outcomes of thoracoscopically assisted colon interposition for LGEA. Keywords Long-gap esophageal atresia · Esophageal substitution · Esophagocoloplasty · Thoracoscopy · Thoracoscopically assisted · Infants
Introduction Esophageal atresia (EA) is a rare congenital malformation [1, 2]. The distance between esophageal ends that constitutes a long-gap EA (LGEA) lacks a strict numerical definition. However, the term is used to describe cases in which a primary anastomosis of the proximal and distal ends of the esophagus cannot easily be performed [3, 4]. Management of newborns with LGEA remains a challenge for pediatric surgeons and controversial [5]; when the primary anastomosis is not possible, alternative techniques Electronic supplementary material The online version of this article (https://doi.org/10.1007/s42804-020-00061-x) contains supplementary material, which is available to authorized users.
are necessary to re-establish esophageal continuity. The only two indications for the esophageal replacement in a child are LGEA and esophageal stenosis unresponsive to other treatments [6, 7]. None conduit has demonstrated to be superior; only familiarity with the different techniques and local expertise can determine success [4, 8, 9]. In our institute, esophagocoloplasty is our first choice for esophageal replacement. We usually place the colon retrosternally, but in the last years, we treated two patients with LGEA who had previously undergone a sternotomy. Therefore, in both cases, we decided to place the graft via an intrathoracic route, but the passage of the colic graft into the thorax was
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