Journal of Indian Association of Pediatric Surgeons
Journal of Indian Association of Pediatric Surgeons
                                                   Official journal of the Indian Association of Pediatric Surgeons                           
Year : 2008  |  Volume : 13  |  Issue : 1  |  Page : 7--10

The role of gastrostomy in the staged operation of esophageal atresia


Seyed Mohammad Vahid Hosseini, Sam Zeraatian Nejad Davani, Babak Sabet, Hamid Reza Forutan, Maryam Sharifian 
 Department of Pediatric Surgery, Shiraz University of Medical Sciences, Shiraz, Iran

Correspondence Address:
Sam Zeraatian Nejad Davani
Department of Pediatric Surgery, Shiraz University of Medical Sciences, Shiraz
Iran

Introduction: The aim of this study is to recommend criteria for selection of patients who benefited from the use of gastrostomy rather than emergency fistula closure during the staged operation of esophageal atresia (EA). Materials and Methods: Between August 2004 and July 2006, 75 cases of EA, were consecutively operated. Nineteen out of 75 (25%) underwent routine gastrostomy because they required a type of staged operation: Group I: Five cases with pure atresia had gastrostomy and esophagostomy; Group II: Six with severe pneumonia and congenital heart disease (Waterson class C) had gastrostomy and conservative management; Group III: Eight with long gap EA (2-4 vertebras); four out of 8 cases underwent primary anastomosis with tension and the other four had delayed primary anastomosis plus primary gastrostomy. Results: GI: Only three cases survived after esophageal substitution; GII: Three out of six cases with severe pneumonia (fistula size: f > 2.5 mm) underwent emergency fistula closure with only one survival, but all (f < 2.5 mm) recovered without complication, GIII: Four patients with long gap and primary anastomosis with tension developed anastomotic leakage; they required gastrostomy following the leakage, except for those with delayed primary anastomosis, and all of them recovered without early complications. Conclusion : All the cases with long gap, although two esophageal ends can be reached with tension, should undergo delayed primary closure with primary gastrostomy. Those were brought with Waterson class C and the fistula size greater than 2.5 mm should undergo emergency fistula closure; however, if fistula size was less than 2.5 mm, it is better to be delayed by primary gastrostomy for stabilization. In this study, we had a better outcome with gastric tube for substitution than colon interposition in infants.


How to cite this article:
Hosseini SM, Davani SZ, Sabet B, Forutan HR, Sharifian M. The role of gastrostomy in the staged operation of esophageal atresia.J Indian Assoc Pediatr Surg 2008;13:7-10


How to cite this URL:
Hosseini SM, Davani SZ, Sabet B, Forutan HR, Sharifian M. The role of gastrostomy in the staged operation of esophageal atresia. J Indian Assoc Pediatr Surg [serial online] 2008 [cited 2021 Jun 25 ];13:7-10
Available from: https://www.jiaps.com/article.asp?issn=0971-9261;year=2008;volume=13;issue=1;spage=7;epage=10;aulast=Hosseini;type=0