[Tubulized gastric fundus in the treatment of esophageal atresia]. / Fundus gástrico tubulizado en el tratamiento de las atresias de esófago de segmento largo.

When is impossible to restore the oesophageal continuity in oesophageal atresia (EA), the stomach elevation (whether tubulized or complete) and colon interposition are the most accomplished techniques, usually from the age of six month, in different steps and with the result of a high mortality, prolonged hospitalizations and high familial and economical cost. From a total of 34 EA diagnosed in an eleven years period, we had treated three children, tubulizing the gastric fundus with mechanical sutures in continuity with the distal oesophageal end in neonatal period. The procedure is done with preservation of the distal esophageal end in continuity with the tubuliced gastric fundus with mecanichal staplers. All the patients had needed pneumatic dilatations of the anastomosis After eleven years, eight years and six months follow-up respectively, the clinical behaviour of those patients is suitable, without swallowing problems and with weight and height development in predictable limits. We think that this kind of neoesophagus is useful to treat the long segment EA in newborns as it sets an esophago-gastric tube orthotopically, with homogeneous diameter in a isoperistaltic continuity, in neonatal period and in one step, putting aside the gastrostomy performed at the firsts hours of life and obtaining an important decreasing of mobility and hospitalisation stay.

Fundus gástrico tubulizado en el tratamiento de las atresias de esófago de segmento largo / Tubulized gastric fundus in the treatment of esophageal atresia

Cuando resulta imposible restablecer la continuidad esofágica en las atresias de esófago (AE), el ascenso del estómago sólo y/otubulizado y la interposición de colon son las técnicas más realizadas, normalmente a partir de los 6 meses de edad, en varios tiempos y con alta morbilidad, larga estancia hospitalaria y alto coste social, familiar y económico. Hemos tratado a tres niños con AE, de un total de 34 AE diagnosticadas, en un período de 11 años, tubulizando el fundus gástrico, con suturas mecánicas, en continuidad con el cabo distal esofágico, en período neonatal. La técnica (basada en la técnica de Schärli) conlleva la tubulización desde la curvatura menor gástrica del fundus gástrico, mediante el uso de suturas mecánicas en continuidad con el cabo distal esofágico. De esta manera se efectúa una anastomosis esofago esofágica conservando el cardias y tubulizando el estómago en sentido isoperistáltico. Todos los pacientes han requerido dilataciones neumáticas de la anastomosis esofago esofágica. El control y seguimiento tras 11 años, 8 años y 8meses es satisfactorio en los tres pacientes, los cuales se encuentran bien, sin problemas de deglución y con un aceptable y adecuado desarrollo pondoestatural. Creemos que este tipo de intervención y realización de un neoesófago es útil para tratar las AE de segmento largo en neonatos, al emplazar un tubo esofagogástrico ortotópicamente de calibre homogéneo en continuidad isoperistáltica en período neonatal y en un solo tiempo, prescindiendo de la gastrostomía realizada a las pocas horas de vida, consiguiendo una importante reducción de la morbilidad y estancia hospitalaria (AU)

When is impossible to restore the oesophageal continuity in oesophageal atresia (EA), the stomach elevation (whether tubulized or complete) and colon interposition are the most accomplished techniques, usually from the age of six month, in different steps and with the result of a high mortality, prolonged hospitalizations and high familial and economical cost. From a total of 34 EA diagnosed in an eleven years period, we had treated three children, tubulizing the gastric fundus with mechanical sutures in continuity with the distal oesophageal end in neonatal period. The procedure is done with preservation of the distal esophageal end in continuity with the tubuliced gastric fundus with mecanichal staplers. All the patients had needed pneumatic dilatations of the anastomosis After eleven years, eight years and six months follow-up respectively, the clinical behaviour of those patients is suitable, without swallowing problems and with weight and height development in predictable limits. We think that this kind of neoesophagus is useful to treat the long segment EA in newborns as it sets an esophago-gastric tube orthotopically, with homogeneous diameter in a isoperistaltic continuity, in neonatal period and in one step, putting aside the gastrostomy performed at the firsts hours of life and obtaining an important decreasing of mobility and hospitalisation stay When is impossible to restore the oesophageal continuity in oesophageal atresia (EA), the stomach elevation (whether tubulizedor complete) and colon interposition are the most accomplished techniques, usually from the age of six month, in different steps and with the result of a high mortality, prolonged hospitalizations and high familial and economical cost. From a total of 34 EA diagnosed in an eleven years period, we had treated three children, tubulizing the gastric fundus with mechanical sutures in continuity with the distal oesophageal end in neonatal period. The procedure is done with preservation of the distal esophageal end in continuity with the tubuliced gastric fundus with mecanichal staplers. All the patients had needed pneumatic dilatations of the anastomosis After eleven years, eight years and six months follow-up respectively, the clinical behaviour of those patients is suitable, without swallowing problems and with weight and height development in predictable limits. We think that this kind of neoesophagus is useful to treat the long segment EA in newborns as it sets an esophago-gastric tube orthotopically, with homogeneous diameter in a isoperistaltic continuity, in neonatal period and in one step, putting aside the gastrostomy performed at the firsts hours of life and obtaining an important decreasing of mobility and hospitalisation stay (AU)