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Surgical outcomes of different approaches to esophageal replacement in long-gap esophageal atresia: A systematic review.

Abstract Esophageal replacement (ER) surgery has been widely used in long-gap esophageal atresia (LGEA) over the past few decades. The most commonly used surgical approaches in many pediatric surgical centers include colon interposition (CI), gastric pull-up (GPU), jejunal interposition (JI), and gastric tube reconstruction (GTR). However, there is no systematic evidence on which is the optimal conduit for the native esophagus. The aim of this systematic review was to evaluate the short- and long-term outcomes among these 4 replacement approaches in LGEA cases based on current evidence.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28538385
OWN - NLM
STAT- MEDLINE
DA  - 20170524
DCOM- 20170612
LR  - 20170612
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 21
DP  - 2017 May
TI  - Surgical outcomes of different approaches to esophageal replacement in long-gap
      esophageal atresia: A systematic review.
PG  - e6942
LID - 10.1097/MD.0000000000006942 [doi]
AB  - BACKGROUND: Esophageal replacement (ER) surgery has been widely used in long-gap 
      esophageal atresia (LGEA) over the past few decades. The most commonly used
      surgical approaches in many pediatric surgical centers include colon
      interposition (CI), gastric pull-up (GPU), jejunal interposition (JI), and
      gastric tube reconstruction (GTR). However, there is no systematic evidence on
      which is the optimal conduit for the native esophagus. The aim of this systematic
      review was to evaluate the short- and long-term outcomes among these 4
      replacement approaches in LGEA cases based on current evidence. METHODS: PubMed, 
      Web of Science, Cochrane Library, and EMBASE were searched for relevant
      literature on November 18 2016. Studies on ER in LGEA were reviewed and selected 
      according to eligibility criteria. We focused on surgical outcomes regarding to
      different replacement approaches, including postoperative complications and
      long-term follow-up. Both detailed descriptions of single studies and pooled data
      analysis were conducted. Data were computed by Reviewer Manager 5.3. RESULTS:
      Twenty-three studies were included (4 comparative retrospective, 3 prospective,
      and 16 retrospective) with a total of 593 patients (393 LGEA, 66.3%). The number 
      of patients with available data for analysis was 534 (90.1%), including 127
      patients (98 LGEA) of GPU, 335 (223 LGEA) of CI, 45 (all LGEA) of JI, and 27 (all
      LGEA) of GTR. Follow-up information was provided in 15 studies. Anastomotic leak 
      and stricture, respiratory problems, and gastroesophageal reflux were analyzed as
      major postoperative complications. Long-term follow-ups were concentrated on
      growth and feeding conditions. CONCLUSION: Current evidence on short- and
      long-term outcomes of ER in LGEA patients was limited, and proper prospective
      comparative studies were lacking. This present systematic review indicates CI and
      GPU as comparable and favorable approaches, especially CI in the long-term
      outcomes. Studies on JI and GTR were limited, which need larger sample size to
      assess their validity and outcomes.
FAU - Liu, Jia
AU  - Liu J
AD  - Department of Pediatric Surgery, Children's Hospital of Fudan University,
      Shanghai, China.
FAU - Yang, Yifan
AU  - Yang Y
FAU - Zheng, Chao
AU  - Zheng C
FAU - Dong, Rui
AU  - Dong R
FAU - Zheng, Shan
AU  - Zheng S
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Esophageal Atresia/*surgery
MH  - Esophagoplasty/adverse effects/*methods
MH  - Esophagus/*surgery
MH  - Humans
PMC - PMC5457865
EDAT- 2017/05/26 06:00
MHDA- 2017/06/13 06:00
CRDT- 2017/05/25 06:00
AID - 10.1097/MD.0000000000006942 [doi]
AID - 00005792-201705260-00026 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 May;96(21):e6942. doi: 10.1097/MD.0000000000006942.

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