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. 2017 May;96(21):e6942.
doi: 10.1097/MD.0000000000006942.

Surgical outcomes of different approaches to esophageal replacement in long-gap esophageal atresia: A systematic review

Jia Liu  1 , Yifan Yang, Chao Zheng, Rui Dong, Shan Zheng
Affiliations

Surgical outcomes of different approaches to esophageal replacement in long-gap esophageal atresia: A systematic review

Jia Liu et al. Medicine (Baltimore). 2017 May.

Abstract

Background: Esophageal replacement (ER) surgery has been widely used in long-gap esophageal atresia (LGEA) over the past few decades. The most commonly used surgical approaches in many pediatric surgical centers include colon interposition (CI), gastric pull-up (GPU), jejunal interposition (JI), and gastric tube reconstruction (GTR). However, there is no systematic evidence on which is the optimal conduit for the native esophagus. The aim of this systematic review was to evaluate the short- and long-term outcomes among these 4 replacement approaches in LGEA cases based on current evidence.

Methods: PubMed, Web of Science, Cochrane Library, and EMBASE were searched for relevant literature on November 18 2016. Studies on ER in LGEA were reviewed and selected according to eligibility criteria. We focused on surgical outcomes regarding to different replacement approaches, including postoperative complications and long-term follow-up. Both detailed descriptions of single studies and pooled data analysis were conducted. Data were computed by Reviewer Manager 5.3.

Results: Twenty-three studies were included (4 comparative retrospective, 3 prospective, and 16 retrospective) with a total of 593 patients (393 LGEA, 66.3%). The number of patients with available data for analysis was 534 (90.1%), including 127 patients (98 LGEA) of GPU, 335 (223 LGEA) of CI, 45 (all LGEA) of JI, and 27 (all LGEA) of GTR. Follow-up information was provided in 15 studies. Anastomotic leak and stricture, respiratory problems, and gastroesophageal reflux were analyzed as major postoperative complications. Long-term follow-ups were concentrated on growth and feeding conditions.

Conclusion: Current evidence on short- and long-term outcomes of ER in LGEA patients was limited, and proper prospective comparative studies were lacking. This present systematic review indicates CI and GPU as comparable and favorable approaches, especially CI in the long-term outcomes. Studies on JI and GTR were limited, which need larger sample size to assess their validity and outcomes.

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Conflict of interest statement

The authors have no conflicts of interest.

Figures

Figure 1
Figure 1
The PRISMA 2009 flow diagram for articles inclusion of this systematic review.
See this image and copyright information in PMC

References

    1. Mitchell IM, Goh DW, Roberts KD, et al. Colon interposition in children. Br J Surg 1989;76:681–6. - PubMed
    1. 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;236:531–9. - PMC - PubMed
    1. Hadidi AT. A technique to improve vascularity in colon replacement of the esophagus. Eur J Pediatric Surg 2006;16:39–44. - PubMed
    1. Tannuri U, Maksoud-Filho JG, Tannuri AC, et al. Which is better for esophageal substitution in children, esophagocoloplasty or gastric transposition? A 27-year experience of a single center. J Pediatr Surg 2007;42:500–4. - PubMed
    1. Al-Shanafey S, Harvey J. Long gap esophageal atresia: an Australian experience. J Pediatr Surg 2008;43:597–601. - PubMed

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