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Eur J Pediatr Surg. 2014 Feb;24(1):3-8. doi: 10.1055/s-0033-1350058. Epub 2013 Aug 9.

International survey on the management of esophageal atresia.

Author information

  • 1Department of Pediatric Surgery, University College London Institute of Child Health, London, United Kingdom.
  • 2Department of Pediatric and Adolescents Surgery, Medical University of Graz, Graz, Austria.
  • 3Department of Pediatric Surgery, National Children's Research Centre, Dublin, Ireland.
  • 4Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
  • 5Department of Pediatric Surgery, Klagenfurt General Hospital, Klagenfurt, Austria.
  • 6Neonatal Surgery Unit, Bambino Gesù Children's Research Hospital, Rome, Italy.
  • 7Department of Pediatric Surgery, Faculty of Medicine, University Children's Hospital, Belgrade, Serbia.
  • 8Department of Pediatric Surgery, Erasmus MC, Sophia in Erasmus MC Sophia Childrens' Hospital, Rotterdam, The Netherlands.
  • 9Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany.
  • 10Department of Pediatric Surgery, University Hospital of Padua, Padova, Italy.
  • 11Department of Pediatric Surgery, Hospital for Children and Adolescents, Helsinki, Finland.

Abstract

INTRODUCTION:

Because many aspects of the management of esophageal atresia (EA) are still controversial, we evaluated the practice patterns of this condition across Europe.

METHODS:

A survey was completed by 178 delegates (from 45 [27 European] countries; 88% senior respondents) at the EUPSA-BAPS 2012.

RESULTS:

Approximately 66% of respondents work in centers where more than five EA repairs are performed per year. Preoperatively, 81% of respondents request an echocardiogram, and only 43% of respondents routinely perform preoperative bronchoscopy. Approximately 94% of respondents prefer an open approach, which is extrapleural in 71% of respondents. There were no differences in use of thoracoscopy between Europeans (10%) and non-Europeans (11%, p = nonsignificant). Approximately 60% of respondents measure the gap intraoperatively. A transanastomotic tube (90%) and chest drain (69%) are left in situ. Elective paralysis is adopted by 56% of respondents mainly for anastomosis tension (65%). About 72% of respondents routinely request a contrast study on postoperative day 7 (2-14). Approximately 54% of respondents use parenteral nutrition, 40% of respondents start transanastomotic feeds on postoperative day 1, and 89% of respondents start oral feeds after postoperative day 5. Pure EA: 46% of respondents work in centers that repair two or more than two pure EA a year. About 60% of respondents opt for delayed primary anastomosis at 3 months (1-12 months) with gastrostomy formation without esophagostomy. Anastomosis is achieved with open approach by 85% of respondents. About 47% of respondents attempt elongation of esophageal ends via Foker technique (43%) or with serial dilations with bougies (41%). Approximately 67% of respondents always attempt an anastomosis. Gastric interposition is the commonest esophageal substitution.

CONCLUSION:

Many aspects of EA management are lacking consensus. Minimally invasive repair is still sporadic. We recommend establishment of an EA registry.

Georg Thieme Verlag KG Stuttgart · New York.

PMID:
23934626
[PubMed - indexed for MEDLINE]
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