O-03 (16:29 to 16:41): Long Gap Esophageal AtresiaÂ: A French National Cohort Study from 2008 to 2010

Résumé fourni par la source

To describe current management and mid-term outcomes for patients with Long Gap Esophageal Atresia (LGEA) in France. We retrospectively analyzed the whole medical charts of all LGEA cases identified in the French Esophageal Atresia (EA) Registry and managed between 2008 and 2010. We included all infants born with an EA in whom primary anastomosis could not be achieved before 1 month of life because of the length of the gap. Forty-nine children were included, 37 type I, 5 type II, 6 type III and 1 type IV according to Ladd's classification. The median gestational age and weight at birth were respectively 36 weeks (26.8–41) and 2060 g (550–3740). A surgical gastrostomy was performed in all cases, combined with closure of tracheoesophageal fistula (n = 8), esophagostomy (n = 4) or Foker's technique (n = 2). Twenty children experienced a complication of whom two died. EA repair was performed either by delayed anastomosis (n = 33, 70%) or esophageal replacement (n = 14, 30%) at a median age and weight of 87 days (19–454) and 4250 g (2400–8300) respectively. The esophageal replacement techniques were gastric transposition (n = 8), gastric tube (n = 3), colon interposition (n = 2) and Collis-Nissen procedure (n = 1). Ninety complications were reported in thirty-eight patients (81%) including 22 anastomotic leaks and 28 anastomotic strictures. At the end of the follow up, the mortality rate was 12%. Most of the french surgeons management strategies favored a delayed anastomosis for LGEA. Despite a good survival rate of 88%, the morbidity remained high and diverse, highlighting the need for multidisciplinary management.

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