RESUMEN
La atresia esofágica de brecha larga es la falta congénita de continuidad del esófago con o sin comunicación a la vía aérea, donde una extensa separación entre los cabos esofágicos (mayor de cuatro centímetros) impide una anastomosis primaria. Para su tratamiento existen varias técnicas, pero ninguna es ideal. Se reportó un paciente transicional masculino, de un año y tres meses de edad, de raza blanca, procedente de Manzanillo, Granma, con diagnóstico de atresia esofágica de brecha larga en la etapa neonatal, al cual se le realizó sustitución esofágica temprana con estómago. Se revisó el expediente clínico del paciente, y se extrajeron los datos relacionados con los antecedentes, el cuadro clínico, los exámenes complementarios y el tratamiento.
Long gap esophageal atresia is the congenital lack of the continuity of esophagus with or without communication to the air way, where an extensive separation between the esophageal pouches (more than four centimeters) inhibit the primary anastomosis. For its treatment there are several techniques, but none of them is ideal. A male patient, with diagnosis of long gap esophageal atresia in the neonatal stage was reported, to whom the early esophageal replacement with stomach was performed. The patient's clinical record was revised, of which the data related with the history, the clinical manifestations, the complementary exams and the treatment were taken.
RESUMEN
Objective To assess the benefit of intraoperatively placed nasointestinal feeding tubes for early postoperative enteral nutrition.Methods The retrospective study was carried out on 19 cases of in-fants with long gap esophageal atresia who underwent one-stage operation in Xinhua Hospital from January 2006 to December 2013.Patients were divided into two groups according to whether the transanastomotic na-sointestinal feeding tubes(TNFT)were placed.Demographics,associated anomalies,operative findings,com-plications,duration of enteral nutrition(EN),length of stay were analyzed.Results Thirty-seven patients had long gap esophageal atresia and nineteen underwent one-stage operation.Eight patients were identified as TNFT group while eleven patients were identified as nonfeeding tube(NFT)group.There was no significant differences between the two groups in gestational age,birth weight,associated anomalies,anastomotic leak, weight gain,ICU-free days and length of stay(P>0.05).But the ventilator-free days(23.5 d vs.19.3 d), first EN time(0.8 d vs.9.1 d)and total EN feeding time(15.9 d vs.21.4 d)between the two groups were significantly different(P<0.05 ).Conclusion Intraoperatively placed TNFT may lead to earlier EN feeding and shorter parenteral nutrition duration,but a larger prospective study would be required to prove the benefits and ensure the safety.
RESUMEN
Objective To explore the application and efficacy of one-stage gastric transposition in long-gap esophageal atresia.Methods 11 patients of long-gap esophageal atresia who received one-stage gastric transposition treatment from March 2008 to December 2013 were analyzed.8 male and 3 female babies were included in the study.The diagnosis was made based on esophageal radiography.And there were 2 cases of type Ⅰ and 9 cases of type Ⅲ a.Results All procedures were completed,9 cases were cured,1 case died and 1 case refused further treatment after operation.6 cases developed pneumonia postoperatively,2 cases had signs of stoma leakage.All cases were followed up for 6 months to 5 years.3 cases had anastomotic stricture and they were cured by balloon dilation.6 cases had mild gastroesophageal reflux but no anti-reflux procedure was needed.And gastroesophageal reflux symptoms were improved by smaller meals and appreciate the feeding treatment.Conclusion One-stage gastric transposition is feasible and acceptable in treating long-gap esophageal atresia in neonates,it can avoid staging operation,shorten the treatment period,and help to improve the cure rate.
RESUMEN
The repair of esophageal atresia with a long gap still continues to pose difficulties for the surgeon. There is general agreement that the child's own esophagus is best, but it is also believed that a primary repair is not always possible. Foker JE et al. (1997) developed a technique of esophageal lengthening using external traction sutures. We experienced one case of esophageal atresia with a 4.5cm gap (4 vertebral spaces) which was repaired using the external traction suture technique.