Download PDF
Eur J Pediatr Surg 2015; 25(04): 312-317
DOI: 10.1055/s-0035-1562926
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Bridging the Gap in the Repair of Long-Gap Esophageal Atresia: Still Questions on Diagnostics and Treatment

Daniel von Allmen
1   Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
,
Rene M. H. Wijnen
2   Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
› Author Affiliations
Further Information

Publication History

24 June 2015

26 June 2015

Publication Date:
24 August 2015 (online)

Also available at
    Permissions and Reprints

Abstract

Long-gap esophageal atresia remains a complex surgical problem fraught with complications and poor outcomes in many patients. This review covers the techniques and strategies currently used to address this congenital anomaly. The techniques covered include preservation of the native esophagus, esophageal elongation techniques, esophageal replacement, and evolving work on tissue engineering.

Keywords

long-gap esophageal atresia - colon interposition - Foker technique
 

  • References

  • 1 Hands LJ, Dudley NE. A comparison between gap-length and Waterston classification as guides to mortality and morbidity after surgery for esophageal atresia. J Pediatr Surg 1986; 21 (5) 404-406
    CrossrefPubMedGoogle Scholar
  • 2 Brown AK, Tam PKH. Measurement of gap length in esophageal atresia: a simple predictor of outcome. J Am Coll Surg 1996; 182 (1) 41-45
    PubMedGoogle Scholar
  • 3 Coran AG. Ultra-long-gap esophageal atresia: how long is long?. Ann Thorac Surg 1994; 57 (3) 528-529
    CrossrefPubMedGoogle Scholar
  • 4 Foker JE, Linden BC, Boyle Jr EM, Marquardt C. Development of a true primary repair for the full spectrum of esophageal atresia. Ann Surg 1997; 226 (4) 533-541 , discussion 541–543
    CrossrefPubMedGoogle Scholar
  • 5 Zani A, Eaton S, Hoellwarth ME , et al. International survey on the management of esophageal atresia. Eur J Pediatr Surg 2014; 24 (1) 3-8
    PubMedGoogle Scholar
  • 6 Lindahl H. Esophageal atresia: a simple technical detail aiding the mobilization and circular myotomy of the proximal segment. J Pediatr Surg 1987; 22 (2) 113-114
    CrossrefPubMedGoogle Scholar
  • 7 Livaditis A, Rådberg L, Odensjö G. Esophageal end-to-end anastomosis. Reduction of anastomotic tension by circular myotomy. Scand J Thorac Cardiovasc Surg 1972; 6 (2) 206-214
    CrossrefPubMedGoogle Scholar
  • 8 Schwartz MZ. An improved technique for circular myotomy in long-gap esophageal atresia. J Pediatr Surg 1983; 18 (6) 833-834
    CrossrefPubMedGoogle Scholar
  • 9 Kimura K, Nishijima E, Tsugawa C, Matsumoto Y. A new approach for the salvage of unsuccessful esophageal atresia repair: a spiral myotomy and delayed definitive operation. J Pediatr Surg 1987; 22 (11) 981-983
    CrossrefPubMedGoogle Scholar
  • 10 Lindahl H, Louhimo I. Livaditis myotomy in long-gap esophageal atresia. J Pediatr Surg 1987; 22 (2) 109-112
    CrossrefPubMedGoogle Scholar
  • 11 Singh A, Bajpai M, Sharma N, Panda SS. Experience with livaditis circular myotomy in management of long gap TEF. Afr J Paediatr Surg 2014; 11 (1) 35-38
    CrossrefPubMedGoogle Scholar
  • 12 Tannuri U, Teodoro WR, de Santana Witzel S , et al. Livaditis' circular myotomy does not decrease anastomotic leak rates and induces deleterious changes in anastomotic healing. Eur J Pediatr Surg 2003; 13 (4) 224-230
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Freud E, Blumenfeld A, Zer M, Sandbank J, Horev G, Giler S. Use of Vicryl mesh to support the esophageal wall after circular myotomy (Livaditis procedure) in long-gap esophageal atresia - an experimental study. Pediatr Surg Int 1996; 11 (8) 539-543
    CrossrefPubMedGoogle Scholar
  • 14 Kimura K, Soper RT. Multistaged extrathoracic esophageal elongation for long gap esophageal atresia. J Pediatr Surg 1994; 29 (4) 566-568
    CrossrefPubMedGoogle Scholar
  • 15 Kimura K, Nishijima E, Tsugawa C , et al. Multistaged extrathoracic esophageal elongation procedure for long gap esophageal atresia: Experience with 12 patients. J Pediatr Surg 2001; 36 (11) 1725-1727
    CrossrefPubMedGoogle Scholar
  • 16 Bobanga ID, Barksdale EM. Foker Technique for the Management of Pure Esophageal Atresia: Long-Term Outcomes at a Single Institution. Eur J Pediatr Surg 2015; (e-pub ahead of print). doi: 10.1055/s-0035-1546757
    PubMedGoogle Scholar
  • 17 Domènech AB, Gutiérrez C, Moratalla T, Lluna J, Barrios JE, Vila JJ. Long gap esophageal atresia: Schärli versus Foker [in Spanish]. Cir Pediatr 2013; 26 (2) 69-74
    PubMedGoogle Scholar
  • 18 Ortiz R, Galán AS, Martinez L , et al. Tertiary surgery for complicated repair of esophageal atresia. Eur J Pediatr Surg 2015; 25 (1) 20-26
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Paya K, Schlaff N, Pollak A. Isolated ultra-long gap esophageal atresia - successful use of the foker technique. Eur J Pediatr Surg 2007; 17 (4) 278-281
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Sroka M, Wachowiak R, Losin M , et al. The Foker technique (FT) and Kimura advancement (KA) for the treatment of children with long-gap esophageal atresia (LGEA): lessons learned at two European centers. Eur J Pediatr Surg 2013; 23 (1) 3-7
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Bairdain S, Hamilton TE, Smithers CJ , et al. Foker process for the correction of long gap esophageal atresia: Primary treatment versus secondary treatment after prior esophageal surgery. J Pediatr Surg 2015; 50 (6) 933-937
    CrossrefPubMedGoogle Scholar
  • 22 Nasr A, Langer JC. Mechanical traction techniques for long-gap esophageal atresia: a critical appraisal. Eur J Pediatr Surg 2013; 23 (3) 191-197
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 van der Zee DC, Gallo G, Tytgat SH. Thoracoscopic traction technique in long gap esophageal atresia: entering a new era. Surg Endosc 2015; (e-pub ahead of print). doi: 10.1007/s00464-015-4091-3
    PubMedGoogle Scholar
  • 24 Spitz L. Gastric transposition via the mediastinal route for infants with long-gap esophageal atresia. J Pediatr Surg 1984; 19 (2) 149-154
    CrossrefPubMedGoogle Scholar
  • 25 Loukogeorgakis SP, Pierro A. Replacement surgery for esophageal atresia. Eur J Pediatr Surg 2013; 23 (3) 182-190
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Cowles RA, Coran AG. Gastric transposition in infants and children. Pediatr Surg Int 2010; 26 (12) 1129-1134
    CrossrefPubMedGoogle Scholar
  • 27 Spitz L. Gastric transposition in children. Semin Pediatr Surg 2009; 18 (1) 30-33
    CrossrefPubMedGoogle Scholar
  • 28 Hirschl RB, Yardeni D, Oldham K , et al. Gastric transposition for esophageal replacement in children: experience with 41 consecutive cases with special emphasis on esophageal atresia. Ann Surg 2002; 236 (4) 531-539 , discussion 539–541
    CrossrefPubMedGoogle Scholar
  • 29 Holland AJ, Ron O, Pierro A , et al. Surgical outcomes of esophageal atresia without fistula for 24 years at a single institution. J Pediatr Surg 2009; 44 (10) 1928-1932
    CrossrefPubMedGoogle Scholar
  • 30 Lacher M, Froehlich S, von Schweinitz D, Dietz HG. Early and long term outcome in children with esophageal atresia treated over the last 22 years. Klin Padiatr 2010; 222 (5) 296-301
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Tannuri U, Maksoud-Filho JG, Tannuri AC, Andrade W, Maksoud JG. Which is better for esophageal substitution in children, esophagocoloplasty or gastric transposition? A 27-year experience of a single center. J Pediatr Surg 2007; 42 (3) 500-504
    CrossrefPubMedGoogle Scholar
  • 32 Ron O, De Coppi P, Pierro A. The surgical approach to esophageal atresia repair and the management of long-gap atresia: results of a survey. Semin Pediatr Surg 2009; 18 (1) 44-49
    CrossrefPubMedGoogle Scholar
  • 33 Burgos L, Barrena S, Andrés AM , et al. Colonic interposition for esophageal replacement in children remains a good choice: 33-year median follow-up of 65 patients. J Pediatr Surg 2010; 45 (2) 341-345
    CrossrefPubMedGoogle Scholar
  • 34 Stone MM, Fonkalsrud EW, Mahour GH, Weitzman JJ, Takiff H. Esophageal replacement with colon interposition in children. Ann Surg 1986; 203 (4) 346-351
    CrossrefPubMedGoogle Scholar
  • 35 Gupta L, Bhatnagar V, Gupta AK, Kumar R. Long-term follow-up of patients with esophageal replacement by reversed gastric tube. Eur J Pediatr Surg 2011; 21 (2) 88-93
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Gallo G, Zwaveling S, Van der Zee DC, Bax KN, de Langen ZJ, Hulscher JB. A two-center comparative study of gastric pull-up and jejunal interposition for long gap esophageal atresia. J Pediatr Surg 2015; 50 (4) 535-539
    CrossrefPubMedGoogle Scholar
  • 37 Gallo G, Zwaveling S, Groen H, Van der Zee D, Hulscher J. Long-gap esophageal atresia: a meta-analysis of jejunal interposition, colon interposition, and gastric pull-up. Eur J Pediatr Surg 2012; 22 (6) 420-425
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Maghsoudlou P, Eaton S, De Coppi P. Tissue engineering of the esophagus. Semin Pediatr Surg 2014; 23 (3) 127-134
    CrossrefPubMedGoogle Scholar
  • 39 Totonelli G, Maghsoudlou P, Fishman JM , et al. Esophageal tissue engineering: a new approach for esophageal replacement. World J Gastroenterol 2012; 18 (47) 6900-6907
    CrossrefPubMedGoogle Scholar
  • 40 Hoogeveld H, Koens M, Geutjes P , et al. Seamless vascularized large-diameter tubular collagen scaffolds reinforced with polymer knittings for esophageal regenerative medicine. Tissue Eng Part C Methods 2014; 20 (5) 423-430
    CrossrefPubMedGoogle Scholar