Skip to main content
SpringerLink
Log in

Esophagoesophagopexy technique for assisted fistulization of esophageal atresia

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

We describe our experience using a modified suture fistula technique for addressing tension in longer gap esophageal atresia (EA). Esophagoesophagopexy (EEP) is the tacking of the proximal and distal ends of esophageal pouches without formal anastomosis. In this retrospective cohort, we review the outcomes of patients with EA after EEP.

Methods

We reviewed the operative reports of EA cases treated at our institution from 1997 to 2016 and identified all patients described as having EEP.

Results

Of 129 EA cases, five patients underwent EEP. Formal anastomosis was not done due to patient’s instability, prematurity, or long gap. Median birth weight was 1.4 kg (0.6–2.2 kg), and median gestational age at birth was 29 weeks (25–34 weeks). Age at time of EEP ranged 0–5 months. Esophagoesophageal fistula was confirmed in three patients. All three had strictures requiring weekly dilations. One of these patients died. The two surviving patients underwent fundoplication.

Conclusion

We describe an alternative technique for esophageal anastomosis in patients for whom a standard anastomosis is not possible. EEP can lead to a functional anastomosis through fistulization and avoid the morbidity of multiple thoracotomies and lengthening procedures. Families should be educated on the potential need for dilations and antireflux procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

EA:

Esophageal atresia

EEP:

Esophagoesophagopexy

EEF:

Esophagoesophageal fistula

TEF:

Tracheoesophageal fistula

References

  1. Foker JE, Linden BC, Boyle EM Jr et al (1997) Development of a true primary repair for the full spectrum of esophageal atresia. Ann Surg 226:533–543

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Schullinger JN, Vinocur CD, Santulli TV (1982) The suture fistula technique in the repair of selected cases of esophageal atresia. J Pediatr Surg 17:234–236

    Article  CAS  PubMed  Google Scholar 

  3. Brown S, Nixon HH (1983) Spontaneous anastomosis of the esophagus in esophageal atresia. J Pediatr Surg 18:293–295

    Article  CAS  PubMed  Google Scholar 

  4. Kimura K, Nishijima E, Tsugawa C et al (1987) A new approach for the salvage of unsuccessful esophageal atresia repair: a spiral myotomy and delayed definitive operation. J Pediatr Surg 22:981–983

    Article  CAS  PubMed  Google Scholar 

  5. Kimura K, Soper RT (1994) Multistaged extrathoracic esophageal elongation for long gap esophageal atresia. J Pediatr Surg 29:566–568

    Article  CAS  PubMed  Google Scholar 

  6. Kimura K, Nishijima E, Tsugawa C et al (2001) Multistaged extrathoracic esophageal elongation procedure for long gap esophageal atresia: experience with 12 patients. J Pediatr Surg 36:1725–1727

    Article  CAS  PubMed  Google Scholar 

  7. Al-Qahtani AR, Yazbeck S, Rosen NG et al (2003) Lengthening technique for long gap esophageal atresia and early anastomosis. J Pediatr Surg 38:737–739

    Article  PubMed  Google Scholar 

  8. Shafer AD, David TE (1974) Suture fistula as a means of connecting upper and lower segments in esophageal atresia. J Pediatr Surg 9:669–673

    Article  CAS  PubMed  Google Scholar 

  9. Marshall DG (1987) An alternative to an interposition procedure in esophageal atresia. J Pediatr Surg 22:775–778

    Article  CAS  PubMed  Google Scholar 

  10. Stringel G, Lawrence C, McBride W (2010) Repair of long gap esophageal atresia without anastomosis. J Pediatr Surg 45:872–875

    Article  PubMed  Google Scholar 

  11. Tovar JA, Fragoso AC (2011) Current controversies in the surgical treatment of esophageal atresia. Scand J Surg 100(4):273–278

    Article  CAS  PubMed  Google Scholar 

  12. Mahour GH, Woolley MM, Gwinn JL (1974) Elongation of the upper pouch and delayed anatomic reconstruction in esophageal atresia. J Pediatr Surg 9:373–383

    Article  CAS  PubMed  Google Scholar 

  13. Hendren WH, Hale JR (1975) Electromagnetic bougienage to lengthen esophageal segments in congenital esophageal atresia. N Engl J Med 293:428–432

    Article  CAS  PubMed  Google Scholar 

  14. Zaritzky M, Ben R, Zylberg GI, Yampolsky B (2009) Magnetic compression anastomosis as a nonsurgical treatment for esophageal atresia. Pediatr Radiol 39:945–949

    Article  PubMed  Google Scholar 

  15. Karabulut R, Turkyilmaz Z, Sonmez K, Ozbayoglu A, Basaklar AC (2014) An approximation technique for primary anastomosis (Gazi Method) in selected cases of long gap esophageal atresia. Prensa Med Argent 100(1):1–3

    Article  Google Scholar 

  16. Gallo G, Zwaveling S, Groen H, Van der Zee D, Hulscher J (2012) Long-gap esophageal atresia: a meta-analysis of jejunal interposition, colon interposition, and gastric pull-up. Eur J Pediatr Surg 22(6):420–425

    Article  PubMed  Google Scholar 

  17. Livaditis A, Radberg L, Odensjo G (1972) Esophageal end-to-end anastomosis. Reduction of anastomotic tension by circular myotomy. Scand J Thorac Cardiovasc Surg 6:206–214

    Article  CAS  PubMed  Google Scholar 

  18. Jaureguizar E, Vazquez J, Murcia J et al (1985) Morbid musculoskeletal sequelae of thoracotomy for tracheoesophageal fistula. J Pediatr Surg 20:511–514

    Article  CAS  PubMed  Google Scholar 

  19. Freeman NV, Walkden J (1969) Previously unreported shoulder deformity following right lateral thoracotomy for esophageal atresia. J Pediatr Surg 4:627–636

    Article  CAS  PubMed  Google Scholar 

  20. Durning RP, Scoles PV, Fox OD (1980) Scoliosis after thoracotomy in tracheoesophageal fistula patients. J Bone Joint Surg Am 62:1156–1158

    Article  CAS  PubMed  Google Scholar 

  21. Cherup LL, Siewers RD, Futrell JW (1986) Breast and pectoral muscle maldevelopment after anterolateral and posterolateral thoracotomies in children. Ann Thorac Surg 41:492–497

    Article  CAS  PubMed  Google Scholar 

  22. Westfelt JN, Nordwall A (1991) Thoracotomy and scoliosis. Spine 16:1124–1125

    Article  CAS  PubMed  Google Scholar 

  23. Chetcuti P, Myers NA, Phelan PD et al (1989) Chest wall deformity in patients with repaired esophageal atresia. J Pediatr Surg 24:244–247

    Article  CAS  PubMed  Google Scholar 

  24. Gauderer MW (2003) Delayed blind-pouch apposition, guide wire placement, and nonoperative establishment of luminal continuity in a child with long gap esophageal atresia. J Pediatr Surg 38:906–909

    Article  PubMed  Google Scholar 

  25. Foker JE, Krosch TCK et al (2009) Long-gap esophageal atresia treated by growth induction: the biological potential and early follow-up results. Semin Pediatr Surg 18:23–29

    Article  PubMed  Google Scholar 

  26. Mochizuki K, Shinkai M, Take H et al (2012) A modified Foker’s technique for long gap esophageal atresia. Pediatr Surg Int 28:851–854

    Article  PubMed  Google Scholar 

  27. Van der Zee DC (2011) Thoracoscopic elongation of the esophagus in long gap esophageal atresia. J Pediatr Gastroenterol Nutr 52:S13-S15

    Google Scholar 

  28. Van der Zee DC, Gallo G, Tytgat SHA (2015) Thoracoscopic traction technique in long gap esophageal atresia: entering a new era. Surg Endosc 29:3324–3330

    Article  PubMed  PubMed Central  Google Scholar 

  29. Wanaguru D, Langusch C, Krishnan U, Variavandi V, Jiwane A, Adams S, Henry G (2017) Is fundoplication required after the Foker procedure for long gap esophageal atresia? J Pediatr Surg 52(7):1117–1120

    Article  PubMed  Google Scholar 

  30. Garritano S, Irino T, Scandavini CM, Tsekrekos A, Lundell L, Rouvelas I (2017) Long-term functional outcomes after replacement of the esophagus in pediatric patients: a systematic literature review. J Pediatr Surg 52(9):1398–1408

    Article  PubMed  Google Scholar 

  31. Cimador M, Carta M, Di Pace MR, Natalè G, Castiglione A, Sergio M, Corsello G, De Grazia E (2006 Feb) Primary repair in esophageal atresia. The results of long term follow-up. Minerva Pediatr 58(1):9–13

    CAS  PubMed  Google Scholar 

  32. Tomaselli V, Volpi ML, Dell’Agnola CA, Bini M, Rossi A, Indriolo A (2003) Long-term evaluation of esophageal function in patients treated at birth for esophageal atresia. Pediatr Surg Int 19(1–2):40–43 (Epub 2002 Nov 14)

    CAS  PubMed  Google Scholar 

  33. Lal DR, Gadepalli SK, Downard CD, Ostlie DJ, Minneci PC, Swedler RM, Chelius T, Cassidy L, Rapp CT, Deans KJ, Fallat ME, Finnell SME, Helmrath MA, Hirschl RB, Kabre RS, Leys CM, Mak G, Raque J, Rescorla FJ, Saito JM, St Peter SD, von Allmen D, Warner BW, Sato TT, Midwest Pediatric Surgery Consortium (2017) Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 52(8):1245–1251

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Lan T. Vu

    Present address: Division of Pediatric Surgery, University of California San Francisco, 550 16th Street, 5th Floor, San Francisco, CA, 94158-0570, USA

Authors and Affiliations

  1. Division of Pediatric Surgery, University of California San Francisco, 550 16th Street, 5th Floor, San Francisco, CA, 94158-0570, USA

    Isabelle Chumfong, Hanmin Lee, Benjamin E. Padilla & Tippi C. MacKenzie

Authors
  1. Isabelle Chumfong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hanmin Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benjamin E. Padilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tippi C. MacKenzie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lan T. Vu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lan T. Vu.

Ethics declarations

Funding

This work was supported by the National Institutes of Health [5T32DK007573-27].

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chumfong, I., Lee, H., Padilla, B.E. et al. Esophagoesophagopexy technique for assisted fistulization of esophageal atresia. Pediatr Surg Int 34, 63–69 (2018). https://doi.org/10.1007/s00383-017-4164-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-017-4164-6

Keywords

Search

Navigation