Comparison Of The Effects Of Different Methods For Long-gap Esophageal Atresia

Object:To compare the effects of different therapeutic strategies in the treatment of long-gap esophageal atresia(LGEA).Materials and Methods:A retrospective analysis of medical records of children who received operation for LGEA was made,which were extracted from the electronic medical record system from 2002 to 2021.According to the different treatment strategies,patients were divided into four groups including(A)primary ananstomosiswas made after elongation of esophage;(B)delayed primary ananstomosis after esophageal lengthening;(C)delayed primary ananstomosis after esophageal traction;(D)esophageal replacement.Multiple data were collected and analysed,consisting of general conditions,perioperative conditions,early complications,late complications,long-term postoperative nutritional.SPSS 25.0 was used for statistical analysis.The counting data was expressed by frequency and cross-table Chi-square test was adopted.Fisher’s exact test was used if the minimum expectation was not met.Measurement data in non-normal distribution was represented by quartile and non-parametric Kruskal-Wallis test was used.Statistical differences can be found when P <0.05.Results:1.Infants in group A had the lowest proportion of gastrostomy,the shortest operation time,the least intraoperative bleeding,the lowest incidenceof anastomotic fistula and the shortest hospitalization time(P<0.05).2.Although there was no significant difference between infants in group B and C inproportion of gastrostomy,operation time,intraoperative bleeding and hospital stay.Children in group C had higher risk of anastomotic fistula(P<0.05).3.In group D,the proportion of gastrostomy was higher than that in group A,but lower than group B and C(P<0.05);the operation time was longer than group A(P<0.05),but similar to those in group B and C.The intraoperative bleeding of group D was similar to that in group B but was more than group A and C(P<0.05).Moreover,patients in group D also had the highest risk of anastomotic leakage(P<0.05)and longer hospitalization time than that in group A(P<0.05),but similar to group B and C.There is no statistical difference in late complications and long-term postoperative nutritional status among the four groups.Conclusion:Intraoperative prolongation of the esophagus with stage I anastomosis is a better choice among all the treatment strategies.In addition,gastrostomy is required for all infants when delayed primary ananstomosis after esophageal lengthening and traction,and early and late complications of them are similar.Esophageal replacement is related to the highest incidence of anastomotic,relatively long operation time,more intraoperative bleeding and relatively longer hospitalization time,which means that esophageal replacement is not the preferred choice for LGEA patients.But in those cases that there is little distal esophageal residue or even no intrathoracic esophagus at all,that stage I anastomosis cannot be made after delayed operation,and that stubborn esophageal scar stricture and recurrent tracheoesophageal fistula after esophageal anastomosis occur,esophageal replacement can still be the final choice.