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Bridging the Gap―More than Surgery Only
31 August 2015 (online)
Since the first successful primary repair of esophageal atresia in 1941, improvements in operative and perioperative care have led to better outcomes, and thus we have seen an evolvement from mortality to morbidity and quality-of-life issues. In fact, esophageal atresia is no longer a mere neonatal surgical problem but rather a lifelong problem for the patient. It appears that respiratory, nutritional, and gastroenterological issues are the most prevalent sequelae—not only in the first years of life but also in adolescence and adulthood.
Synergizing the expertise of the different specialists in the multifaceted aspects of esophageal atresia, the International Network of Esophageal Atresia (INoEA) was founded in 2013 after two successful conferences in Lille (2010) and Montreal (2012) paved the way. The European Journal of Pediatric Surgery encourages these kinds of multidisciplinary initiatives and invited keynote speakers of the Rotterdam conference in 2014 to review the developments in the last 5 to 10 years in their specialties. This resulted in the articles included in this special issue on esophageal atresia. From a surgical point of view, long-gap esophageal atresia is still the most challenging type, for which new but also modified older techniques are used, as reviewed by von Allmen and Wijnen. Regrettably, repair of the continuity of the esophagus does not restore the peristalsis as well, with motility disorders and feeding problems as a result—reviewed, respectively, by Conforti et al. And then, it is not only the esophagus that is affected, but also the trachea, so that different types of malacia occur. Snijders and Barbato provide an update of current diagnostic modalities and classification of tracheomalacia. As was pointed out above, after the neonatal period the problems are not solved for these patients. Many will develop esophagitis, often due to gastroesophageal reflux, but also due to eosinophilic inflammation, which can be highly therapy resistant. And in the longer term, the chance to develop Barrett esophagus or cancer is far much higher compared with the general population. Recapitulated, esophageal atresia is not only a neonatal congenital malformation, but also a disease which exerts its effects over the life course. Its management needs the efforts of a multidisciplinary innovative approach. These review articles describe the many advancements already made, which I am sure will be expanded on in our next conference in Sydney in 2016.