Análisis de la evolución clínico-quirúrgica de neonatoscon atresia de esófago con cabos distantes (Long Gap)durante el crecimiento espontáneo de los mismos / Analysis of clinical-surgical course of neonates with long-gap esophageal atresia during their spontaneous growth

Introducción. La atresia de esófago (AE) es una de las patologías quirúrgicas de mayor prevalencia en la etapa neonatal. La corrección quirúrgica es posible despues del nacimiento, pero en ocasiones la distancia entre los cabos esofágicos (CE) imposibilita la anastomosistérmino-terminal (ATT) inicial. La definición de Long Gap (LG) oCE distantes es imprecisa y, si bien hay consenso en que la conservación del esófago propio es la mejor opción terapéutica, existen controversias sobre la oportunidad e impacto clínico que ocasiona la espera del crecimiento de los cabos esofágicos en forma espontánea tal como lo ha propuesto P. Puri. Objetivos. Evaluar la evolución clínico-quirúrgica de los recién nacidos (RN) con AELG durante el ingres en la unidad de cuidados intensivos neonatales (UCIN) de un hospital pediátrico. Material y métodos. Estudio descriptivo, retrospectivo. Se incluyeron todos los RN con AELG ingresados en la UCIN desde enero de2002 a diciembre de 2006. Se analizó sexo, edad gestacional, peso al nacer (PN), tipo de AE, distancia entre CE, complicaciones respiratorias y quirúrgicas, edad al alta y mortalidad. Resultados. En 5 años ingresaron a la UCIN 64 RN con AE; 21(33%) fueron LG (población de estudio). En 8 RN (38%), se logró realizar una ATT (80 ± 40 días); todos tuvieron reflujo gastroesofágico(RGE), el 50% presentó complicaciones: dehiscencia o estenosis de la (..) (AU)

Introduction. Esophageal atresia (EA) is one of the most prevalent surgical conditions in the newborn. Sometimes early oesophagealanastomosis can’t be done due to the esophageal gap. Long gap (LG)definition is not precise. Although consensus exist about conservation of owns esophagus is the best therapeutic option, literature is not clear about how long and under what circunstances is advisable to wait for the spontaneous esophageal pouches to growth (P. Puri approach). Furthermore at present we don’t even know the real repercussion that this waiting can implicate. Objective. The aim of the study was to evaluate the clinical and (..) (AU)

[Analysis of clinical-surgical course of neonates with long-gap esophageal atresia during their spontaneous growth]. / Análisis de la evolución clinico-quirúrgica de neonatos con atresia de esófago con cabos distantes (Long Gap) durante el crecimiento espontáneo de los mismos.

INTRODUCTION: Esophageal atresia (EA) is one of the most prevalent surgical conditions in the newborn. Sometimes early oesophageal anastomosis can't be done due to the esophageal gap. Long gap (LG) definition is not precise. Although consensus exist about conservation of owns esophagus is the best therapeutic option, literature is not clear about how long and under what circunstances is advisable to wait for the spontaneous esophageal pouches to growth (P. Puri approach). Furthermore at present we don't even know the real repercussion that this waiting can implicate. OBJECTIVE: The aim of the study was to evaluate the clinical and surgical outcome of newborns with EALG during their stay in a neonatal intensive care unit (NICU) at a third level children's hospital. MATERIALS AND METHODS: We retrospectively reviewed the charts of all newborn with EA admitted in the NICU from January 2002 to December 2006 in order to analyze sex, gestacional age, weight, type of EA, LG, respiratory and surgical complications, length of stay and mortality. RESULTS: During the study time period 64 newborns with EAwere admitted, 21 (33%) had EALG (our population). We underwent primary repair with esophageal anastomosis in 8 newborns at 80 +/- 40 days. All of them had gastroesophageal reflux, 50% presented different complications such as anastomotic leak, stricture and mediastinal infections. 13 patients required an esophagostomy at a mean age of 46 +/- 34 days due to a lack of growth of esophageal's pouches and/or serious respiratory complications. There were no deaths. CONCLUSIONS: There were high percentages of esophagostomized patients. The result of waiting for the primary repair was a high number of children with chronic lung disease and a high rate of serious complications. Esophageal anastomosis were accompanied by long hospital stays and no clear benefits. The early application of dynamic esophageal lengthening should be explored as an alternative strategy for newborns with EALG.