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Thoracoscopic external traction suture elongation for the management of long-gap oesophageal atresia: a two-centre experience

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Abstract

Aim

Van der Zee (VdZ) described a technique to elongate the oesophagus in long-gap oesophageal atresia (LGOA) by thoracoscopic placement of external traction sutures (TPETS). Here, we describe our experience of using this technique.

Method

Retrospective review of all LGOA + / − distal tracheo-oesophageal fistula (dTOF) cases where TPETS was used in our institutions. Data are given as medians (IQR).

Results

From 01/05/2019 to 01/03/2023, ten LGOA patients were treated by the VdZ technique. Five had oesophageal atresia (Gross type A or B, Group 1) and five had OA with a dTOF (type C, Group 2) but with a long gap precluding primary anastomosis.

Age of first traction procedure was Group 1 = 53 (29–55) days and Group 2 = 3 (1–49) days. Median number of traction procedures = 3; time between first procedure and final anastomosis was 6 days (4–7). Four cases were converted to thoracotomy at the third procedure. Three had anastomotic leaks managed conservatively.

Follow-up was 12–52 months. All patients achieved oesophageal continuity and were orally fed; no patient required an oesophagostomy.

Conclusion

In this series, TPETS in LGOA facilitated delayed primary anastomoses and replicated the good results previously described but, in addition, was successful in cases with dTOF. We believe traction suture placement and tensioning benefit from being performed thoracoscopically because of excellent visualisation and the fact that the tension does not change when the chest is closed. Surgical and anaesthetic planning and expertise are crucial. It is now our management of choice in OA patients with a long gap with or without a distal TOF.

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Data availability

No datasets were generated or analysed during the current study.

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Acknowledgements

The authors would like to thank Mr Tony Lander for his support in reviewing this manuscript.

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Authors and Affiliations

  1. Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK

    Snigdha Reddy, Ingo Jester, Giampiero Soccorso, Max Pachl, Hetal Patel & G. Suren Arul

  2. Sheffield Children’s Hospital, Sheffield, UK

    Elizabeth Gavens

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  1. Snigdha Reddy
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  2. Ingo Jester
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  3. Giampiero Soccorso
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  4. Max Pachl
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  5. Elizabeth Gavens
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  6. Hetal Patel
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  7. G. Suren Arul
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Contributions

Author responsibility form for article: ‘THORACOSCOPIC EXTERNAL TRACTION SUTURE ELONGATION FOR THE MANAGEMENT OF LONG-GAP ESOPHAGEAL ATRESIA WITH OR WITHOUT DISTAL TRACHEO-ESOPHAGEAL FISTULA’. Dr. Suren Arul, Consultant Paediatric Surgeon, confirms that the following authors were involved in this paper. S R: study design, data collection, writing paper; I J: data collection, writing paper; G S: data collection, writing paper; E G: data collection, writing paper; M P: data collection, writing paper; HP: writing paper; SA: started project, study design, data collection, writing paper.

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Correspondence to G. Suren Arul.

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Reddy, S., Jester, I., Soccorso, G. et al. Thoracoscopic external traction suture elongation for the management of long-gap oesophageal atresia: a two-centre experience. Pediatr Surg Int 40, 135 (2024). https://doi.org/10.1007/s00383-024-05707-y

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