Long-gap esophageal atresia. torakoskopy or toracotomy?
DOI:
https://doi.org/10.15574/PS.2017.56.38Keywords:
newborn, long-gap esophageal atresia, thoracoscopy, Foker procedureAbstract
Esophageal atresia is a сongenital malformation, in which the continuity of the esophagus is impaired and there are two segments that are not interconnected. Each of segments may end blind pouches or with a fistula that attached to the tracheobronchial tree. Newborns with this defect need surgical treatment. Survival of children with esophageal atresia is currently 95–98%. Failures happen if the baby was born much before a term and has the combined malformations, and/or pneumonia. Besides, the long-gap esophageal atresia is considered to be a particularly difficult clinical case. To solve this problem, various methods are proposed. Foker’s procedure has been used successfully. The procedure for elongation can be performed both with thoracotomic and thoracoscopic access.Objective. To analyze treatment outcomes in children with long-gap esophageal atresia (LGEA).
Material and methods. In the clinic of pediatric surgery of the Tyumen State Medical University 9 Foker procedures were performed. Four of which were made using the thoracoscopic access. In one patient both stages were managed to carry out mini-invasively.
Results. Thoracoscopic elongation of esophagus did not increase the number of early and late postoperative complications.
Conclusions. World experience shows that thoracoscopic surgeries have better long-term results. The surgeon’s task is to ensure saving of the patient’s own esophagus, even in case of LGEA. This task helps to be solved the procedure of elongation by J. Foker. Our experience shows that using the method of Foker Wulf, you can not only save the esophagus without damaging its tissue, but also to conduct as a primary operation (the external or internal traction sutures are placed), as well as to form the esophago-esophagoanastomosis thoracoscopically.
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