Esophageal substitution or esophageal elongation procedures in patients with complicated esophageal atresia? Results of a comparative study

Background: In newborns with complex esophageal atresia, there are situations in which a primary anastomosis cannot be safely performed. The alternative is performing a late anastomosis after the esophageal ends have gone through a period of spontaneous growth or after elongations of the distant ends of the esophagus and create an anastomosis under tension which causes risks of morbidity. An alternative to the elongation procedures is to per -form a cervical esophagostomy with a gastrostomy for nutritional support and later on an esophageal replace-ment. The purposes of this retrospective chart review study are to report on our experience with esophageal substitution procedures in such cases, address the quality of life of a group of patients, and compare our results with those of patients who underwent esophageal elongation procedures as reported in the literature. Methods: Patients with esophageal atresia underwent esophageal replacement procedures and quality of life was assessed in a group of esophagocoloplasty patients. Results: From February 1978 to July 2019, 276 children (232 colonic interpositions and 44 total gastric transpo-sitions) were studied; the most frequent complication was cervical anastomosis leakage [70 (30.2%) esophagocoloplasty patients and 7 (15.9%) gastric transposition patients], which sealed spontaneously in all but 4 patients. The quality of life was considered excellent or good in approximately 90% of the studied 70 out of the 276 patients; the comparison with the esophageal elongation procedures showed that esophageal substi-tution procedures promoted excellent long-term results with normal deglutition function (98.2% of patients, versus 33.3%, 36.5%, and 62.5%, respectively from the elongation series, P <0.0001 for all comparisons). Conclusion: Esophagocoloplasty or total gastric transposition is a good alternative to treat patients with complex esophageal atresia. Type of study: Retrospective study. Level of evidence: Level III. (c) 2020 Published by Elsevier Inc.