Destro Francesca, Maestri Luciano, Meroni Milena, Rebosio Federico, Del Re Giulia, Mantegazza Cecilia, Calcaterra Valeria, Pelizzo Gloria
Pediatric Surgery Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy.
Department of Pediatrics, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy.
Children (Basel). 2021 Jan 17;8(1):55. doi: 10.3390/children8010055.
Gastro-esophageal reflux disease (GERD), requiring surgical correction, and nutritional problems are reported after long-gap esophageal atresia (LGEA) repair and might jeopardize the postoperative course in some babies. We report an exploratory evaluation of the role of transgastric jejunostomy (TGJ) as a temporary nutritional tool before surgery for GERD in LGEA.
Seven infant patients operated on for LGEA with intra-thoracic gastro-esophageal junction (GEJ) and growth failure, requiring improvement in their nutritional profile in anticipation of surgery, were retrospectively evaluated. Post-surgical follow-up, including growth evolution, complications, and parental quality of life (QoL), were considered.
The TGJ was placed at a mean age of 8.6 ± 5.6 months. The procedure was uneventful and well-tolerated in all seven cases. At 6.6 ± 2.0 months after TGJ placement, significant weight gain (weight z-score -2.68 ± 0.8 vs -0.9 ± 0.2, < 0.001) was recorded, allowing the GERD surgery to proceed. A significant difference in hospital admissions between 3 months before and post-TGJ insertion was noted (4.8 ± 0.75 vs. 1.6 ± 0.52, < 0.01). A significant amelioration of QoL after TGJ placement was also recorded; in particular, the biggest improvements were related to parents' perceptions of the general health and emotional state of their babies ( < 0.001).
The placement of TGJ as a temporary nutritional tool in selected cases of LGEA could improve nutritional conditions and parental QoL before fundoplication, allowing successful surgical treatment of GERD to be carried out.
据报道，长间隙食管闭锁（LGEA）修复术后会出现需要手术矫正的胃食管反流病（GERD）和营养问题，这可能会危及一些婴儿的术后进程。我们报告了一项关于经胃空肠造口术（TGJ）作为LGEA患者GERD手术前临时营养工具作用的探索性评估。
回顾性评估了7例接受LGEA手术且胸内胃食管交界处（GEJ）存在问题以及生长发育迟缓、预计手术前需要改善营养状况的婴儿患者。考虑了术后随访情况，包括生长发育进展、并发症以及家长的生活质量（QoL）。
TGJ放置的平均年龄为8.6±5.6个月。该手术在所有7例患者中均顺利进行且耐受性良好。在TGJ放置后6.6±2.0个月时，记录到体重显著增加（体重Z评分从-2.68±0.8变为-0.9±0.2，P<0.001），从而得以进行GERD手术。注意到TGJ插入前3个月与插入后住院次数存在显著差异（4.8±0.75 vs. 1.6±0.52，P<0.01）。TGJ放置后QoL也有显著改善；特别是，最大的改善与家长对其婴儿总体健康和情绪状态的认知有关（P<0.001）。
在选定的LGEA病例中放置TGJ作为临时营养工具，可以在胃底折叠术之前改善营养状况和家长的QoL，从而使GERD得以成功进行手术治疗。
