Objective
To explore the management strategies of type Ⅰ esophageal atresia (EA) through natural growth and tension-extension.
Methods
From January 2012 to January 2017, a total of 10 children of type-Ⅰ EA were recruited.There were 5 boys and 5 girls.Difficult postnatal insertion of gastric tube prompted a clinical diagnosis of type-Ⅰ EA after esophagography.Within a month after birth, laparoscopic gastrostomy was performed.During operation, the distance between proximal and distal esophagus was measured on esophageal radiography.And nutrient liquid was supplied via gastrostomy.Saliva was reabsorbed through proximal esophagus and esophageal growth measured regularly.Esophageal extension was achieved through natural growth and tension-extension.Thus thoracoscopic gastroesophagostomy was delayed.
Results
Two cases of thoracoscopic esophageal anastomosis were achieved through natural growth.The completion ages were 153 and 151 days respectively.In another eight cases, the distance between proximal and distal esophagus was still greater than the total length of four vertebrates at 12 weeks post-birth.Tension-extension was applied for promoting the growth of esophagus and thoracoscopic gastroesophagostomy performed .And esophagectasia was performed postoperatively for counteracting esophageal stenosis.When starting endo-esophogeal lengthening, the mean age was (174.3±86.6) (92-280) days and the mean vertebral number between esophogeal ends (5.1±0.5)(4.5-6.0). And the extended time was (49.0±16.2) (28-69) days.At Day 7 postoperatively, esophogeal contrasting radiography revealed esophogeal anastomotic fistula (n=2). Both cases were cured after conservative measures.Esophogeal stenosis of varying degrees (n=10) required esophogeal dilatation.During follow-ups, all children had excellent growth and development.
Conclusions
Promoting esophageal extension through natural growth and tension-extension reduces pre-anastomotic surgical trauma and postoperative adhesion.Thoracoscope allows a distinct exsanguine operative field for minimizing surgical trauma.The recovery is satisfactory after treatment.This promising treatment is worth a wider popularization.
Key words:
Esophageal atresia; Thoracoscopes; Esophageal extension
Objective To evaluate our experiences in thoracoscopic repair of congenital esophageal atresia with tracheoesophageal fistula (EATEF) in neonates.Methods The 3-trocar thoracoscopic procedures of esophageal anastomosis and fistula ligation were performed for 69 neonates from January 2010 to January 2014.There were 42 males and 27 females with an age range of 1-48 days and a body weight of 1.4-3.5 kg.In all cases,the diagnosis was made based on esophageal radiological contrast plus echocardiography and abdominal ultrasonography.At the end of procedure,a chest tube was implanted.Results A total of 69 patients underwent thoracoscopic repair.And 63 had one-stage repair successfully.Two operations were converted into open thoracotomy and 4 cases had to be staged due to a long gap between 2 esophageal segments.The average operative duration was 123-± 39 (73-205)min.The amount of bleeding was ＜10 ml except for 40 ml in one case.The mean length of mechani cal ventilation was (2.7 ± 2.3) days.Nine cases had anastomotic leak.The follow-up period was 2-45 months.And 25 neonates developed anastomotic stricture and required esophageal dilatation 1 to 18 times.Recurrent fistula between esophagus and trachea developed in 4 cases.Later one case required laparoscopic fundoplication.And six cases died.Conclusions The thoracoscopic procedure is both safe and effective in the treatment of EATEF.Initial attempts result in a higher incidence of such complications as stricture and leak.Better outcomes may be achieved with technique refinements.
Key words:
Thoracoscopy; Esophageal atresia; Tracheoesophageal fistula
Objective
To explore the application value of suspension traction in laparoscopic suture anastomosis of duodenum.
Methods
Retrospective analyses were conducted for the clinical data of 42 cases with congenital duodenal obstruction (CDO). They were divided into groups A and B according to whether or not suspension traction was applied. Group A (convention, n=13): duodenal membrane atresia (n=7) and annular pancreas (n=6); Group B (suspension traction, n=29): duodenal membrane atresia (n=16), duodenal atresia Ⅱ type (n=3) and annular pancreas (n=10). Three laparoscopic holes were employed in all cases to compare operative duration, number of conversion into open surgery, postoperative stomal leak, anastomotic stenosis, feeding start time and full feeding time, etc.
Results
Comparing Groups A and B, the operative duration for vertical incision of anterior duodenum plus a transverse suture was(87.3±13.2)vs (77.1±11.5) min and diamond-shaped side-to-side anastomosis (135.7±20.8) vs (77.1±11.5) min. In Group A, there were conversion into open surgery (n=2), anastomotic fistula cured by conservative drainage (n=1) and repeated emesis cured conservatively (n=1). Neither conversion into open surgery nor complication occurred during or after operation.
Conclusions
The application of suspension traction provides excellent exposure and operative convenience in laparoscopic suture anastomosis of duodenum. And operative difficulty is reduced with shortened time and enhanced safety.
Key words:
Laparoscopes; Neonate; Duodenum; Pancreas
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