PURPOSE OF THE STUDY

Demonstration of own experience of thoracoscopic traction elongation of the esophagus through the use of internal sutures in 8 infants with a complete description of all stages of operations that lead to the preservation of the native well-contracting esophagus.

MATERIAL AND METHODS

Since January 2017, 8 patients with esophageal atresia, accompanied by large diastasis between segments, have been treated at the center for neonatal surgery of the Ivano-Matreninsky Children’s Clinical Hospital in Irkutsk; in all patients used the technique of traction elongation using internal sutures. Several patients were delivered to the surgical center from various children’s hospitals of the Russian Federation located at a considerable distance from Irkutsk (Krasnodar, Kemerovo, Khabarovsk, Krasnoyarsk). Laparoscopic or open gastrostomy on site was underwent for Most infants (6 newborns). Two patients who were born in Irkutsk did not undergo gastrostomy. During the first thoracoscopy, sutures were placed on the blind ends of the esophagus, which brought the segments together. Repeated thoracoscopy was performed 5-12 days after the application of internal traction sutures, during which a thoracoscopic primary anastomosis of the esophagus was formed. The early and long-term results of laparoscopic operations were studied.

RESULTS

Thoracoscopic traction elongation of the esophagus using internal sutures was successfully used in all 8 children with atresia of the esophagus, accompanied by large diastasis. The average age of patients was 22.6 days (from 1 to 90 days). The average body weight at the time of surgery was 2587.5 g (from 1300 to 3750 g). The length of the diastasis between the proximal and distal segments reached an average of 5.88 cm (5 to 8 cm). The duration of internal traction varied from 5 to 12 days. During repeated thoracoscopy, an anastomosis of the esophagus was applied in all patients with varying degrees of tension. Children were discharged for outpatient aftercare after normalization of nutritional status. During the observation of patients, it was found that 75% of them developed gastroesophageal reflux, which necessitated a laparoscopic antireflux procedure. All children also needed a dilatation of the anastomosis using a balloon. The procedure for balloon dilatation of the esophagus was performed twice in 100% of patients, three times in 75%, more than 4 times in 50%. All children at the end of the study could take food by the mouth and showed normal weight gain and body length.

CONCLUSION

The present study showed that esophageal growth can be initiated even in the smallest segments of the esophagus and allows to form of an externally normal esophagus. Esophageal function, even with uncoordinated contractions in the lower segment, will be satisfactory and consistent with the well-known results of treatment for esophageal atresia.