RESUMO
The authors report an alternative method of cervical esophagostomy that was used in a child with type A esophageal atresia. This method involved performing a lateral esophagostomy in the proximal pouch, preserving its distal end, allowing the child to swallow normally, without choking, while stimulating the spontaneous growth of the proximal esophagus. As a result, the infant could be discharged home on G-tube feedings while waiting for spontaneous growth of the proximal pouch to occur. There were no episodes of aspiration during this period, and definitive reconstruction through end-to-end esophageal anastomosis was accomplished successfully at the age of 18 months. The authors consider that this alternative might increase the possibility of a definitive correction through delayed primary anastomosis of the infant's own esophagus in children with this type of malformation.
Assuntos
Atresia Esofágica/cirurgia , Esofagostomia/métodos , Anastomose Cirúrgica , Cateterismo , Nutrição Enteral , Atresia Esofágica/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , RadiografiaRESUMO
AIM: The aim of this paper is to describe a simple technique of extended hiatoplasty to achieve intraabdominal placement of the distal esophagus and evaluate it manometricaly. METHODS: Twelve mongrel dogs were submitted to esophageal manometry using a balloon system and continuous pull-through technique, before and after being submitted to laparotomy and extended hiatoplasty. Parameters measured included length of the HPZ, maximal recorded pressure and maximal end-expiratory pressure. Pre- and post-operative values were compared using the Wilcoxon non-parametric test accepting 0.05 as a level of significance. RESULTS: There was a significant post-operative increase in the length of the HPZ from 48.22 (+/- 4.33) mm to 68.69 (+/- 14.17) mm (p < 0.05). No significant change in the recorded values of maximal pressure or maximal end-expiratory pressure could be detected. The results indicate that an additional portion of the esophagus was exposed to the positive intraabdominal pressure and that this extended hiatoplasty can be used, together with a fundoplication, to increase the efficacy of the gastro-esophageal barrier.