IMMEDIATE AND REMOTE RESULTS OF ESOPHAGOPLASTY WITH THE APPLICATION OF SEGMENT ELONGATION IN ESOPHAGEAL ATRESIA
Impressive progress has been made in treatment of esophageal atresia in newborns in recent years, but still there are difficulties caused by combination of esophagus malformation with malformation of other organs and organ systems, esophageal atresia and prematurity, as well as situations when diastasis between segments is so large that primary plastic surgery of the esophagus is not possible. The authors have conducted a cohort retrospective study based on the results of treatment of 80 children with esophageal atresia who were admitted to Tyumen Regional Clinical Hospital No. 2 from 2008 to 2018. Group 1 (surmountable diastasis, primary anastomosis) included 60 newborns (33 boys (55%), 27 girls (45%), average body weight 2713±143, 16 premature neonates (26.7%), average gestational age 38±0,6, mean diastasis 2.8±0.3 cm, concomitant malformations in 34 children (56.6%). 57 patients had a lower tracheoesophageal fistula and the other 3 had both, a lower and upper fistula. Plastic surgery of the esophagus with thoracotomy incision was performed in 66.7% of all the cases, thoracoscopic formation of anastomosis was performed in 33.3%. Group 2 (irresistible diastasis, esophagus elongation) included 20 children. 9 of them underwent Livaditis circular myotomy, other 11 underwent Foker procedure of esophagus elongation. In this group, there were 75% of boys, their average body weight was 2217±337, 55% were born prematurely, the average gestational age was 35.4±1.5, the average diastasis was 4.5±0.5 cm, and 70% had concomitant malformations. 85% had a lower tracheoesophageal fistula, 15% had a fistula-free form; 15 anastomoses were formed with thoracotomy, 2 - thoracoscopically. The research showed that esophagus elongation for anastomosis allows for plastic surgery in cases of large diastasis. The incidence of early postoperative complications in children who underwent anastomosis using lengthening technique does not statistically differ from that in children who underwent anastomosis without segment lengthening. The increase in mortality in the group of children whose esophageal patency was restored using lengthening technique is statistically significantly higher, but has cause-effect relationship with birth weight, gestational age and diastasis.