Eur J Pediatr Surg 2013; 23(03): 173-174
DOI: 10.1055/s-0033-1349397
Editorial
Georg Thieme Verlag KG Stuttgart · New York

What Is New in Dealing with Esophageal Atresia

Agostino Pierro
1   Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
› Author Affiliations
Further Information

Publication History

Publication Date:
24 June 2013 (online)

This special issue of the European Journal of Pediatric Surgery is related to esophageal atresia (EA) with or without tracheoesophageal fistula. Various pediatric surgeons from around the world have contributed to the various sections, providing critical evaluation of the progress made in this field.

Gastroesophageal reflux is very frequent after the repair of EA. Tovar and Fragoso[1] from Madrid, Spain report that ~40% of the children affected by this complication require a fundoplication. Unfortunately there if a high rate of wrap failure indicating the need for further research toward an innovative therapy of gastroesophageal in children with repaired EA.

Loukogeorgakis and Pierro from London, UK and Toronto, Canada[2] report the different techniques used to substitute the native esophagus in complex cases of EA. The heterogeneity of patients and outcomes make difficult data pooling and comparison of the different techniques. The authors report the outcome of the commonest techniques in use including colonic interposition, gastric transposition, gastric tube reconstruction, and jejunal interposition. A prospective study based on an international registry seems to be important to improve the outcome of these challenging cases.

Nasr and Langer from Ottawa and Toronto, Canada[3] report a critical appraisal of the traction methods for long-gap EA repair. The Foker technique is compared with the delayed primary anastomosis. The authors suggest an international registry to evaluate prospectively the results obtained with the two above techniques in a large number of children.

Dingemann and Ure[4] from Hannover, Germany evaluate the advantages and disadvantages of the thoracoscopic repair of EA compared with open repair. The results of thoracoscopy seems to be comparable to that reported after open surgery but further studies are needed to investigate the learning curve, the postoperative pain, and the potential reduction in length of hospital stay.

The article from Baird, Laberge, and Lévesque[5] discusses the anastomotic stricture after repair of EA. The role of antiacid treatment to prevent the development of the stricture remains debatable and the authors report that various attempts at reducing the rate of stricture have been largely unsuccessful. In addition to esophageal dilatation, novel treatment of stricture include steroid injection or the topical application of Mitomycin C.

Lal and Oldham from Wisconsin, United States[6] report the various techniques in current use for the diagnosis and treatment of recurrent tracheoesophageal fistula. The results of the classic open repair compared with the more recent endoscopic repair are discussed. The authors highlight the existence of controversy as to which technique is superior.

Finally, Rintala and Pakarinen from Helsinki, Finland[7] report the results of the long-term follow-up of children with EA. The authors draw the attention to the markedly increased incidence of gastroesophageal reflux, oesophagitis, columnar metaplasia and Barrett's esophagus. It is urgently needed to better define the true incidence and risk factors of oesophageal cancer following EA repair and this can be accomplished only by large-scale population-based follow-up studies, preferentially including multiple centers.

These various articles provide an up-to-date evaluation of EA treatment and in common they highlight the need for collaborative international prospective research in children with this rare and challenging anomaly.