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Dokumcu Z, Divarci E, Ozcan C, Erdener A. Single-incision laparoscopy-assisted gastric transposition combined with thoracoscopic esophagectomy for esophageal replacement. Asian J Endosc Surg 2019; 12:366-371. [PMID: 30549226 DOI: 10.1111/ases.12633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/13/2018] [Accepted: 07/03/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We present a novel approach to single-incision laparoscopy-assisted gastric transposition combined with thoracoscopic esophagectomy in a child with long-segment corrosive esophageal stricture (CES). MATERIALS AND SURGICAL TECHNIQUE A 2.5-year-old boy with a history of caustic ingestion underwent periodic esophageal dilatations at 3-week intervals, four sessions of topical mitomycin C application, and a strict antacid/H2 antagonist therapy for 8 months. The esophageal replacement was indicated because of persistent corrosive esophageal stricture. First, thoracoscopic native esophagus dissection was performed. After gastric mobilization with single-incision laparoscopy, esophagectomy and esophagogastric anastomosis were performed through the cervical incision. There was no complication, and the patient had gained weight by the end of the 12-month follow-up. DISCUSSION Single-incision laparoscopy-assisted gastric transposition combined with thoracoscopic esophagectomy is feasible, safe, and effective in patients with corrosive esophageal stricture.
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Affiliation(s)
- Zafer Dokumcu
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Emre Divarci
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Coskun Ozcan
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ata Erdener
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Izmir, Turkey
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2
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Awad K, Jaffray B. Oesophageal replacement with stomach: A personal series and review of published experience. J Paediatr Child Health 2017; 53:1159-1166. [PMID: 28799279 DOI: 10.1111/jpc.13653] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/22/2017] [Accepted: 05/28/2017] [Indexed: 12/22/2022]
Abstract
AIM To describe the outcomes of oesophageal replacement using stomach in children. METHODS All children undergoing oesophageal replacement in a regional centre were prospectively recorded in a customised database and subjected to continual follow up. Complications within 30 days were classified as early, and all other complications were classified as late. Outcomes were related to a comprehensive analysis of published experience where studies were classified as having long-term follow up if the median duration exceeded 5 years. RESULTS Ten children underwent oesophageal replacement using the stomach between 1998 and 2016. Indications were oesophageal atresia (6), caustic ingestion (2), foreign body ingestion (1) and oesophageal hamartoma (1). Two children died at 2 and 7 months after gastric transposition. All survivors are under review, with a median follow up of 8.5 years (range 3-14 years). Complications occurred in every case. Among survivors, three had early complications and eight had late complications. Early complications included anastomotic leak (2) and lung compression by stomach (1). Late complications were anaemia (8), anastomotic stricture (7), oesophagitis (5), dumping syndrome (2), perforation of a jejunostomy (1), para-gastric hiatal hernia (1), gastric outlet obstruction (1), Barrett's oesophagus (1), prolonged inability to swallow (1) and recurrent lower respiratory tract infections (1). Among 57 publications, only three achieved complete long-term follow up. The incidence of reported complications was higher when follow up was complete. CONCLUSIONS Oesophageal replacement by gastric transposition in children leads to serious chronic morbidity. Published experience masks this because of incomplete and short follow up.
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Affiliation(s)
- Karim Awad
- Department of Paediatric Surgery, The Great North Children's Hospital, Newcastle upon Tyne, United Kingdom.,Department of Paediatric Surgery, Ain Shams University Hospitals, Cairo, Egypt
| | - Bruce Jaffray
- Department of Paediatric Surgery, The Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
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3
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Miyano G, Seo S, Nakamura H, Sueyoshi R, Okawada M, Doi T, Koga H, Lane GJ, Yamataka A. Changes in quality of life from infancy to school age after esophagoesophagostomy for tracheoesophageal fistula: thoracotomy versus thoracoscopy. Pediatr Surg Int 2017; 33:1087-1090. [PMID: 28831606 DOI: 10.1007/s00383-017-4141-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND We assessed the quality of life (QOL) of postoperative esophageal atresia (EA) with tracheoesophageal fistula (TEF) cases, comparing open with thoracoscopic repair. METHODS A retrospective review of consecutive EA/TEF repairs (2001-2014) was performed, excluding cases with birth weight less than 2000 g and severe cardiac/chromosomal anomalies. Of 37 cases, 13 had thoracoscopic repair (TR) and 24 had open repair (OR) according to the operating surgeon's preference. QOL was determined regularly by scoring responses to a standard questionnaire about oral intake, vomiting, bougienage, coughing, growth retardation, learning ability, and thoracic deformity. Lower scores reflected poorer outcome. QOL after TR and OR was compared 1 year postoperatively (POQ) and after starting school (ScQ). RESULTS Subject demographics were similar. Apart from two anastomotic leaks that resolved spontaneously after TR, there were no intraoperative complications or recurrence of TEF. Laparoscopic fundoplication was required for gastroesophageal reflux in four cases (OR 1; TR 3) (p = ns). QOL scores went from 6.5 → 11.5 in OR and 4.6 → 11.3 in TR, respectively. Final ScQ scores were similar, but POQ was significantly higher after OR (p < 0.05). CONCLUSION Initial QOL scores were significantly lower after TR, but by school age QOL scores were similar.
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Affiliation(s)
- Go Miyano
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Shogo Seo
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroki Nakamura
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryo Sueyoshi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Manabu Okawada
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Doi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Koga
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Geoffrey J Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
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4
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Zeng Z, Zhang H, Liu F. Therapeutic effect of one-stage esophageal replacement with stomach in newborns in the treatment of long-gap esophageal atresia. Minerva Pediatr 2017; 71:547-548. [PMID: 28471144 DOI: 10.23736/s0026-4946.17.04943-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Zhandong Zeng
- Department of Neonatal Surgery, Xuzhou Children's Hospital, Xuzhou Medical University, Jiangsu, China
| | - Hongwei Zhang
- Department of Neonatal Surgery, Xuzhou Children's Hospital, Xuzhou Medical University, Jiangsu, China -
| | - Fengli Liu
- Department of Neonatal Surgery, Xuzhou Children's Hospital, Xuzhou Medical University, Jiangsu, China
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5
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Abstract
The management of long-gap esophageal atresia remains challenging with limited consensus on the definition, evaluation, and surgical approach to treatment. Efforts to preserve the native esophagus have been successful with delayed primary anastomosis and tension-based esophageal growth induction processes. Esophageal replacement is necessary in a minority of cases, with the conduit of choice and patient outcomes largely dependent on institutional expertise. Given the complexity of this patient population with significant morbidity, treatment and long-term follow-up are best done in multidisciplinary esophageal and airway treatment centers.
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Affiliation(s)
- Hester F Shieh
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Fegan 3, Boston, MA 02115
| | - Russell W Jennings
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Fegan 3, Boston, MA 02115.
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Abstract
This article focuses on esophageal replacement as a surgical option for pediatric patients with end-stage esophageal disease. While it is obvious that the patient׳s own esophagus is the best esophagus, persisting with attempts to retain a native esophagus with no function and at all costs are futile and usually detrimental to the overall well-being of the child. In such cases, the esophagus should be abandoned, and the appropriate esophageal replacement is chosen for definitive reconstruction. We review the various types of conduits used for esophageal replacement and discuss the unique advantages and disadvantages that are relevant for clinical decision-making.
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Affiliation(s)
- Shaun M Kunisaki
- Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children׳s Hospital, University of Michigan Medical School, 1540 E. Hospital Dr, SPC 4211, Ann Arbor, Michigan.
| | - Arnold G Coran
- Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children׳s Hospital, University of Michigan Medical School, 1540 E. Hospital Dr, SPC 4211, Ann Arbor, Michigan
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Abstract
OPINION STATEMENT Esophageal atresia is a rare congenital anomaly, but improved surgical and critical care has resulted in survival rates exceeding 90%. Long-term survival is associated with numerous management challenges including chronic motility disorders, dysphagia, strictures, reflux, esophagitis and attendant complications, tracheomalacia and chronic restrictive lung disease, and recurrent pulmonary infections. No guidelines for adolescents and younger or older adults exist for the treatment and monitoring of this specialized patient population. As such, patients with esophageal atresia can experience life-long sequelae of their disease and are best served by intentional transition to adult care for surveillance and monitoring, specifically for chronic lung disease, reflux, and its complications. This is best accomplished in a multidisciplinary fashion at experienced esophageal and lung centers.
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Affiliation(s)
- Abby White
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Mail: 75 Francis Street, Boston, MA, 02115, USA.
| | - Raphael Bueno
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Mail: 75 Francis Street, Boston, MA, 02115, USA
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8
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Reinberg O. Esophageal replacements in children. Ann N Y Acad Sci 2016; 1381:104-112. [PMID: 27310521 DOI: 10.1111/nyas.13101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/11/2016] [Accepted: 04/19/2016] [Indexed: 12/26/2022]
Abstract
Replacement of the esophagus in children can be performed in cases of malformations, injuries, or acquired conditions. The new esophagus should allow normal oral feeding, with little or no gastroesophageal reflux, and be able to work well for the lifetime of the patient. For over a century, many substitutes have been used, such as segments of colon, the entire stomach, gastric tubes, or parts of the small bowel, but none are perfect or function like a normal esophagus. Esophageal replacements are demanding challenges for pediatric surgeons. Here, I review the different techniques and the pitfalls related to these procedures on the basis of our experience of more than 300 esophageal replacements in children performed since 1989.
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Affiliation(s)
- Olivier Reinberg
- Department of Pediatric Surgery, University Hospital and University of Lausanne, Pully, Switzerland.
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9
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Zambon A, Vetralla M, Urbani L, Pantano MF, Ferrentino G, Pozzobon M, Pugno NM, De Coppi P, Elvassore N, Spilimbergo S. Dry acellular oesophageal matrix prepared by supercritical carbon dioxide. J Supercrit Fluids 2016. [DOI: 10.1016/j.supflu.2016.04.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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10
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Choudhury SR, Yadav PS, Khan NA, Shah S, Debnath PR, Kumar V, Chadha R. Pediatric esophageal substitution by gastric pull-up and gastric tube. J Indian Assoc Pediatr Surg 2016; 21:110-4. [PMID: 27365902 PMCID: PMC4895733 DOI: 10.4103/0971-9261.182582] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aim: The aim of this study was to report the results of pediatric esophageal substitution by gastric pull-up (GPU) and gastric tube (GT) from a tertiary care pediatric center. Materials and Methods: Retrospective analysis of the surgical techniques, results, complications, and final outcome of all pediatric patients who underwent esophageal substitution in a single institution was performed. Results: Twenty-four esophageal substitutions were performed over 15-year period. The indications were pure esophageal atresia (EA)-19, EA with distal trachea-esophageal fistula-2, EA with proximal pouch fistula-1, and esophageal stricture in two patients. Mean age and weight at operation were 17 months and 9.5 kg, respectively. GPU was the most common procedure (19) followed by reverse GT (4) and gastric fundal tube (1). Posterior mediastinal and retrosternal routes were used in 17 and 7 cases, respectively. Major complications included three deaths in GPU cases resulting from postoperative tachyarrhythmias leading to cardiac arrest, cervical anastomotic leak-17, and anastomotic stricture in six cases. Perioperative tachyarrhythmias (10/19) and transient hypertension (2/19) were observed in GPU patients, and they were managed with beta blocker drugs. Postoperative ventilation in Intensive Care Unit was performed for all GPU, but none of the GT patients. Follow-up ranged from 6 months to 15 years that showed short-term feeding difficulties and no major growth-related problems. Conclusions: Perioperative tachyarrhythmias are common following GPU which mandates close intensive care monitoring with ventilation and judicious use of beta blocking drugs. Retrosternal GT with a staged neck anastomosis can be performed without postoperative ventilation.
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Affiliation(s)
- Subhasis Roy Choudhury
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Partap Singh Yadav
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Niyaz Ahmed Khan
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Shalu Shah
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Pinaki Ranjan Debnath
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Virendra Kumar
- Department of Paediatric Intensive Care, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Rajiv Chadha
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
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11
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Angotti R, Molinaro F, Noviello C, Cobellis G, Martino A, Del Rossi C, Bianchi A, Messina M. Gastric transposition as a valid surgical option for esophageal replacement in pediatric patients: experience from three Italian medical centers. Gastroenterol Rep (Oxf) 2016; 5:47-51. [PMID: 27151896 PMCID: PMC5444262 DOI: 10.1093/gastro/gow012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Esophageal replacement in children is an option that is confined to very few situations including long-gap esophageal atresia and esophageal strictures unresponsive to other therapies (peptic or caustic ingestion). The purpose of our work was to describe the experience of gastric transposition in three Italian centers. Methods: This is a retrospective study. The data were extrapolated from a prospective database. We included all patients who had undergone gastric transposition in the last 15 years. Results: In the 15-year period, eight infants and children (3 males and 5 females) underwent gastric transposition for esophageal replacement. Six patients had long-gap esophageal atresia, and two had caustic esophageal stenosis. There were no deaths in the series. Three patients had an early postoperative complication: two had a self-limited salivary fistula at three weeks, and one (a patient with jejunostomy) had a jejunal perforation treated surgically. One late complication, anastomotic stricture, was recorded that required two endoscopic dilatations. The median follow-up was 60 months (range: 18–144 months). At final clinical follow-up, six patients had no eating problems, and two patients had some difficulties with eating (jejunostomy in situ), but they underwent logopedic therapy with improved outcomes. All patients had an increase in body weight and height postoperatively. Conclusion: Our small study reports the clinical experience of three Italian centers in which gastric transposition was performed with excellent results, both in terms of surgical technique (simplicity, reproducibility, complication rate) and clinical follow-up (good oral feeding of young patients, normal social life and regular growth curves).
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Affiliation(s)
- Rossella Angotti
- Division of Pediatric Surgery, Department of Medicine, Surgical and Neurological Sciences, University of Siena, Siena, Italy,
| | - Francesco Molinaro
- Division of Pediatric Surgery, Department of Medicine, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Carmine Noviello
- Pediatric Surgery Unit, Academic Salesi Children Hospital, Marche Polytechnic University, Ancona, Italy
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Academic Salesi Children Hospital, Marche Polytechnic University, Ancona, Italy
| | - Ascanio Martino
- Pediatric Surgery Unit, Academic Salesi Children Hospital, Marche Polytechnic University, Ancona, Italy
| | | | - Adrian Bianchi
- Neonatal and Paediatric Reconstructive Surgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Mario Messina
- Division of Pediatric Surgery, Department of Medicine, Surgical and Neurological Sciences, University of Siena, Siena, Italy
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12
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Chandrakala KR, Nagaraj B, Bhagya DV, Chandrika YR. Challenges in Anaesthetic management of a child for thoracoscopic assisted oesophageal replacement. Indian J Anaesth 2016; 60:127-30. [PMID: 27013752 PMCID: PMC4787124 DOI: 10.4103/0019-5049.176269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The loss of oesophageal length or obliteration of oesophageal lumen due to stricture acquired by accidental caustic ingestion is more common in children that may require major operative reconstruction. A number of procedures have been developed for anatomic replacement of oesophagus of which thoracoscopic assisted gastric transposition has shown the best outcome in children. This demands an extensive pre-operative evaluation, preparation and anaesthetic management since this is challenging and prolonged procedure done under one lung ventilation (OLV). Though it is a minimally invasive procedure, providing OLV and management of complications associated with it are the anaesthetic challenges among these children. We report anaesthetic management of an 8-year-old boy with oesophageal stricture following corrosive injury posted for thoracoscopic assisted gastric transposition.
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Affiliation(s)
- K R Chandrakala
- Department of Paediatric Anaesthesia, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Bindu Nagaraj
- Department of Paediatric Anaesthesia, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - D V Bhagya
- Department of Paediatric Anaesthesia, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Y R Chandrika
- Department of Paediatric Anaesthesia, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
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13
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Sjöqvist S, Jungebluth P, Lim ML, Haag JC, Gustafsson Y, Lemon G, Baiguera S, Burguillos MA, Del Gaudio C, Rodríguez AB, Sotnichenko A, Kublickiene K, Ullman H, Kielstein H, Damberg P, Bianco A, Heuchel R, Zhao Y, Ribatti D, Ibarra C, Joseph B, Taylor DA, Macchiarini P. Experimental orthotopic transplantation of a tissue-engineered oesophagus in rats. Nat Commun 2014; 5:3562. [PMID: 24736316 PMCID: PMC4354271 DOI: 10.1038/ncomms4562] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 03/05/2014] [Indexed: 12/22/2022] Open
Abstract
A tissue-engineered oesophageal scaffold could be very useful for the treatment of pediatric and adult patients with benign or malignant diseases such as carcinomas, trauma or congenital malformations. Here we decellularize rat oesophagi inside a perfusion bioreactor to create biocompatible biological rat scaffolds that mimic native architecture, resist mechanical stress and induce angiogenesis. Seeded allogeneic mesenchymal stromal cells spontaneously differentiate (proven by gene-, protein and functional evaluations) into epithelial- and muscle-like cells. The reseeded scaffolds are used to orthotopically replace the entire cervical oesophagus in immunocompetent rats. All animals survive the 14-day study period, with patent and functional grafts, and gain significantly more weight than sham-operated animals. Explanted grafts show regeneration of all the major cell and tissue components of the oesophagus including functional epithelium, muscle fibres, nerves and vasculature. We consider the presented tissue-engineered oesophageal scaffolds a significant step towards the clinical application of bioengineered oesophagi.
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Affiliation(s)
- Sebastian Sjöqvist
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Philipp Jungebluth
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Mei Ling Lim
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Johannes C Haag
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Ylva Gustafsson
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Greg Lemon
- Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden
| | - Silvia Baiguera
- Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden
| | | | - Costantino Del Gaudio
- Department of Industrial Engineering, Intrauniversitary Consortium for Material Science and Technology (INSTM) Research Unit Tor Vergata, University of Rome, Rome 00133, Italy
| | - Antonio Beltrán Rodríguez
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Alexander Sotnichenko
- International Scientific-Research Clinical and Educational Center of Regenerative Medicine, Kuban State Medical University, Krasnodar 350040, Russian Federation
| | - Karolina Kublickiene
- 1] Center for Gender Medicine, Karolinska Institutet, SE-141 86 Stockholm, Sweden [2] Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86 Stockholm, Sweden
| | - Henrik Ullman
- Department of Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Heike Kielstein
- Department of Anatomy and Cell Biology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, 06108 Halle (Saale), Germany
| | - Peter Damberg
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Alessandra Bianco
- Department of Industrial Engineering, Intrauniversitary Consortium for Material Science and Technology (INSTM) Research Unit Tor Vergata, University of Rome, Rome 00133, Italy
| | - Rainer Heuchel
- 1] Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86 Stockholm, Sweden [2] Center of Biosciences, Karolinska Institutet, SE-141 86 Stockholm, Sweden
| | - Ying Zhao
- 1] Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86 Stockholm, Sweden [2] Center of Biosciences, Karolinska Institutet, SE-141 86 Stockholm, Sweden
| | - Domenico Ribatti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari Medical School, National Cancer Institute 'Giovanni Paolo II', Bari 70121, Italy
| | - Cristián Ibarra
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Bertrand Joseph
- Cancer Centrum Karolinska, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Doris A Taylor
- Texas Heart Institute, Center for Regenerative Medicine, Houston, Texas 770-30, USA
| | - Paolo Macchiarini
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
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14
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Dingemann C, Meyer A, Kircher G, Boemers TM, Vaske B, Till H, Ure BM. Long-term health-related quality of life after complex and/or complicated esophageal atresia in adults and children registered in a German patient support group. J Pediatr Surg 2014; 49:631-8. [PMID: 24726127 DOI: 10.1016/j.jpedsurg.2013.11.068] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 11/25/2013] [Accepted: 11/30/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) after esophageal atresia (EA) repair is postulated to be good. However, little is known about the long-term results after repair of complex and/or complicated EA regarding HRQoL. We investigated long-term HRQoL after delayed anastomosis, esophageal replacement, major revisions, or multiple dilatations in patients registered in a support group. METHODS Patients registered in the German patient support group database (KEKS) were enrolled and allocated to subgroups according to surgical treatment and age. HRQoL was evaluated using validated questionnaires (GIQLI, WHO-5, KIDSCREEN27). RESULTS Complete follow-up (mean 14.5 ± 9.8 years) was available for 90/92 patients. Patients were allocated to subgroups delayed anastomosis (n=28), esophageal replacement (n=27), major revisions (n=15), and multiple dilatations (n=20). Adult patients presented with impaired well-being according to WHO-score and gastrointestinal function (GIQLI). In contrast, HRQoL of children was comparable to controls in most KIDSCREEN27-dimensions. Delayed anastomosis was associated with most-favourable HRQoL. Regarding physical well-being, these children scored significantly better than controls [64.01 ± 10.40 vs. 52.36 ± 8.73;p=0.0011], children after replacement [51.40 ± 5.70;p=0.008], revisions [52.04 ± 6.97;p=0.026], and multiple dilatations [50.22 ± 9.67,p=0.04]. CONCLUSIONS HRQoL after complex and/or complicated EA is excellent in children registered in a patient support group. In adults, disease-specific symptoms negatively affect HRQoL. Our data indicate that saving the esophagus may achieve the best HRQoL.
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Affiliation(s)
- Carmen Dingemann
- Center of Pediatric Surgery, Hannover Medical School and Bult Children's Hospital, Hannover, Germany.
| | - Annica Meyer
- Center of Pediatric Surgery, Hannover Medical School and Bult Children's Hospital, Hannover, Germany
| | - Gabriele Kircher
- German support group for patients with diseased esophagus "KEKS", Stuttgart, Germany
| | - Thomas M Boemers
- Department of Pediatric Surgery and Pediatric Urology, Children's Hospital of Cologne, Cologne, Germany
| | - Bernhard Vaske
- Institute of Biostatistics, Hannover Medical School, Hannover, Germany
| | - Holger Till
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Austria
| | - Benno M Ure
- Center of Pediatric Surgery, Hannover Medical School and Bult Children's Hospital, Hannover, Germany
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15
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Larsen HF, Jensen TSR, Rasmussen L, Ellebæk M, Qvist N. Intramural injection with botulinum toxin significantly elongates the pig esophagus. J Pediatr Surg 2013; 48:2032-5. [PMID: 24094953 DOI: 10.1016/j.jpedsurg.2013.03.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 03/06/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE Surgical treatment of long-gap esophageal atresia (LGEA) is challenging. Methods which facilitate stretching of the esophageal pouches may allow primary anastomosis. Botulinum toxin type A (BTX-A) blocks acetylcholine release in neuromuscular junctions, thereby causing muscle relaxation. We hypothesized that intramural injections with BTX-A into the esophageal wall of piglets would significantly elongate the tissue upon stretch. METHODS Twenty-four piglets were randomized to receive BTX-A of placebo (saline). After one hour, the esophagus was removed en bloc and tested in a stretch-tension device. RESULTS The mean esophageal elongation was 84% (range 83-101) in the BTX-A-group and 65% (50-78) in the control group. The mean difference between the two groups was 18%, which was significant (p < 0.001). CONCLUSION Intramural injections with botulinum toxin type A elongate the esophagus significantly. Clinically, this could be a potential method to achieve primary anastomosis in LGEA. Additional clinical studies are necessary to evaluate the method before it can be generally recommended.
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16
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Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: A comprehensive review. World J Gastroenterol 2013; 19:3918-3930. [PMID: 23840136 PMCID: PMC3703178 DOI: 10.3748/wjg.v19.i25.3918] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/15/2013] [Accepted: 04/28/2013] [Indexed: 02/07/2023] Open
Abstract
Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. The specific pathophysiologic mechanisms are becoming better understood and may have a role in the future management and prevention of long-term consequences, such as esophageal strictures. Whereas the mainstay of diagnosis is considered upper gastrointestinal endoscopy, computed tomography and ultrasound are gaining a more significant role, especially in addressing the need for emergency surgery, whose morbidity and mortality remains high even in the best hands. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Medical or endoscopic prevention of stricture is debatable, yet esophageal stents, absorbable or not, show promising data. Dilatation is the first therapeutic option for strictures and bougies should be considered especially for long, multiple and tortuous narrowing. It is crucial to avoid malnutrition, especially in developing countries where management strategies are influenced by malnutrition and poor clinical conditions. Late reconstructive surgery, mainly using colon transposition, offers the best results in referral centers, either in children or adults, but such a difficult surgical procedure is often unavailable in developing countries. Possible late development of esophageal cancer, though probably overemphasized, entails careful and long-term endoscopic screening.
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17
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Alport’s syndrome: case of a giant esophageal tumor. Esophagus 2013. [DOI: 10.1007/s10388-012-0355-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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18
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Kunisaki SM, Foker JE. Surgical advances in the fetus and neonate: esophageal atresia. Clin Perinatol 2012; 39:349-61. [PMID: 22682384 DOI: 10.1016/j.clp.2012.04.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This article focuses on selected topics in the diagnosis and management of patients with esophageal atresia (EA) with or without tracheoesophageal fistula. The current status of prenatal diagnosis and recent advances in surgical techniques, including thoracoscopic repair for short-gap EA and tension-induced esophageal growth for long-gap EA, are reviewed. Although no consensus exists among pediatric surgeons regarding the role of these procedures in the treatment of EA, one can reasonably expect that, as they evolve, their application will become more widespread in this challenging patient population.
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Affiliation(s)
- Shaun M Kunisaki
- Department of Surgery, Fetal Diagnosis and Treatment Center, C.S. Mott Children's and Von Voigtlander Women's Hospital, University of Michigan Medical School, 1540 East Hospital Drive, SPC 4211, Ann Arbor, MI 48109, USA.
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