Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Pediatr Surg Int. 2023 Apr 4;39(1):166. doi: 10.1007/s00383-023-05448-4.
Pediatric surgeons have yet to reach a consensus whether a gastric sleeve pull-up or delayed primary anastomosis for the treatment of esophageal atresia (EA), especially of the long-gap type (LGEA) should be performed. Thus, the aim of this study was to evaluate clinical outcome, quality of life (QoL), and mental health of patients with EA and their parents.
Clinical outcomes of all children treated with EA from 2007 to 2021 were collected and parents of affected children were asked to participate in questionnaires regarding their Quality of Life (QoL) and their child's Health-Related Quality of Life (HRQoL), as well as mental health.
A total of 98 EA patients were included in the study. For analysis, the cohort was divided into two groups: (1) primary versus (2) secondary anastomosis, while the secondary anastomosis group was subdivided into (a) delayed primary anastomosis and (b) gastric sleeve pull-up and compared with each other. When comparing the secondary anastomosis group, significant differences were found between the delayed primary anastomosis and gastric sleeve pull-up group; the duration of anesthesia during anastomosis surgery (478.54 vs 328.82 min, p < 0.001), endoscopic dilatation rate (100% vs 69%, p = 0.03), cumulative time spent in intensive care (42.31 vs 94.75 days, p = 0.03) and the mortality rate (0% vs 31%, p = 0.03). HRQoL and mental health did not differ between any of the groups.
Delayed primary anastomosis or gastric sleeve pull-up appear to be similar in patients with long-gap esophageal atresia in many key aspects like leakage rate, strictures, re-fistula, tracheomalacia, recurrent infections, thrive or reflux. Moreover, HrQoL was comparable in patients with (a) gastric sleeve pull-up and (b) delayed primary anastomosis. Future studies should focus on the long-term results of either preservation or replacement of the esophagus in children.
小儿外科医生尚未就治疗食管闭锁（EA），特别是长段型（LGEA）的治疗方法达成共识，即胃袖套上提术或延迟一期吻合术。因此，本研究旨在评估 EA 患儿及其父母的临床结果、生活质量（QoL）和心理健康。
收集 2007 年至 2021 年期间接受 EA 治疗的所有儿童的临床资料，并邀请患儿家长参与问卷调查，内容涉及 QoL 和患儿健康相关生活质量（HRQoL）以及心理健康。
共有 98 例 EA 患儿纳入本研究。为了进行分析，将队列分为两组：（1）一期 versus （2）二期吻合，二期吻合组再分为（a）延迟一期吻合和（b）胃袖套上提，并相互比较。在比较二期吻合组时，发现延迟一期吻合与胃袖套上提组之间存在显著差异；吻合术时麻醉时间（478.54 分钟 vs 328.82 分钟，p < 0.001）、内镜扩张率（100% vs 69%，p = 0.03）、重症监护时间（42.31 天 vs 94.75 天，p = 0.03）和死亡率（0% vs 31%，p = 0.03）。任何一组的 HRQoL 和心理健康均无差异。
在长段型 EA 患儿中，延迟一期吻合或胃袖套上提在漏诊率、狭窄、再瘘、气管软化、反复感染、生长或反流等关键方面似乎相似。此外，胃袖套上提与延迟一期吻合的患者 HRQoL 相当。未来的研究应侧重于保留或替代儿童食管的长期结果。
