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. 2020 Jul-Dec;17(3 & 4):45-48.
doi: 10.4103/ajps.AJPS_95_17.

Transhiatal isoperistaltic colon interposition without cervical oesophagostomy in long-gap oesophageal atresia

Cigdem Ulukaya Durakbasa  1 , Murat Mutus  1 , Gonca Gercel  1 , Selma Fettahoglu  1 , Hamit Okur  1
Affiliations

Transhiatal isoperistaltic colon interposition without cervical oesophagostomy in long-gap oesophageal atresia

Cigdem Ulukaya Durakbasa et al. Afr J Paediatr Surg. 2020 Jul-Dec.

Abstract

Background: Oesophageal colonic interposition in oesophageal atresia (OA) patients is almost exclusively done as a staged operation with an initial oesophagostomy and gastrostomy followed by the definitive surgery months later. This study presents a series of patients in whom a cervical oesophagostomy was not performed before the substitution surgery.

Patients and methods: Records of EA patients were evaluated for those who underwent colon interposition without cervical oesophagostomy.

Results: There were five patients: three with pure EA and two with proximal tracheo-oesophageal fistula. A delayed primary repair could not be performed because of intra-abdominally located distal pouch. The mean age at the time of definitive operation was 5.54 (±2.7) months and the mean weight was 6.24 (±1.3) kg. A right or a left colonic segment was used for interposition keeping the proximal anastomosis within the thorax. The post-operative results were quite satisfactory within a median follow-up period of 33.2 months.

Conclusion: Avoiding cervical oesophagostomy and its inherent complications and drawbacks is possible in a subset of patients with long-gap EA who underwent colonic substitution surgery. This approach may be seen as an extension of the consensus that the native oesophagus should be preserved whenever possible, because it uses the native oesophagus in its entirety.

Keywords: Colon interposition; long gap; oesophageal atresia; oesophageal substitution; oesophagostomy.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Images obtained during serial gap measurements in patient 1 on two separate occasions. (a) A spiral endotracheal tube (arrow) through the mouth and a ureter dilatation bougie (broken arrow) is inserted through the gastrostomy and both are pushed. (b) The upper pouch is delineated by contrast medium (arrow) and a Hegar bougie (broken arrow) is inserted through the gastrostomy pushing upwards
Figure 2
Figure 2
Schematic representation of the completed operation. The colonic segment is brought upwards through the oesophageal hiatus and lies in the posterior mediastinum in a straight position. The upper anastomosis is within the thorax. The cologastric anastomosis is located behind the stomach and a pyloroplasty is added
Figure 3
Figure 3
(a and b) Anteroposterior and lateral views of anastomotic stenosis as demonstrated on barium swallow in patient 2. (c) Oesophageal endoscopic balloon dilatation done under fluoroscopic control
See this image and copyright information in PMC

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