Thoracoscopic Traction Technique In Long Gap Esophageal Atresia: Entering A New Era | 25263
Journal of Gastrointestinal & Digestive System
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Objective: To describe the evolution from delayed management of long gap esophageal atresia to thoracoscopic treatment
directly after birth without the placement of a gastrostomy.
Background: Long gap esophageal atresia remains a challenge for pediatric surgeons. Over the years several techniques have
been described to deal with the problem of the distance between the proximal and distal esophagus. More recently a traction
technique has been advocated. With the advent of minimal invasive surgery the thoracoscopic elongation technique has been
Methods: Retrospective description of a single center experience with the thoracoscopic treatment of patients with long gap
esophageal atresia over a 7 year period.
Results: between 2007 and 2013 eleven children with long gap esophageal atresia were treated by thoracoscopic elongation
technique. In two children the procedure failed. In another two direct anastomosis was possible with the use of intrathoracic
traction. Seven children succesfully underwent thoracoscopic traction with delayed primary anastomosis. Initially all patients
had a gastrostomy. During the course, the technique evolved into delayed primary anastomosis directly after birth without the
use of a gastrostomy.
Conclusion: Thoracoscopic elongation technique in long gap esophageal atresia is not only feasible, it can nowadays also
be performed directly after birth without the use of a gastrostomy. With this development we have entered a new era in the
management of long-gap esophageal atresia.
David C Van Der Zee has been Pediatric Surgeon since 1991. He defended his thesis ?Materno-embryonic transfusion and congenital malformations? successfully
in 1996. He has published over 100 peer reviewed papers. He is involved in education and training in IPEG, EAES, NVKCh. He has been Chief of the Department
of Pediatric Surgery in Utrecht since 2006 and has been appointed as Professor in Pediatric Surgery in 2009. He gave the keynote lecture at the JSES on training
in endoscopic surgery in children and neonates and at ELSA. He currently is Editor in several international journals and is 2nd Vice-President of IPEG.
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