An Axillary Skin Crease Incisional Approach for Repairing Esophageal Atresia

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  • Owari Mitsugu
    Department of Pediatric Surgery, Nara Hospital, Kinki University School of Medicine Department of Pediatric Surgery, Osaka University Graduated School of Medicine
  • Yamauchi Katsuji
    Department of Pediatric Surgery, Nara Hospital, Kinki University School of Medicine
  • Kamiyama Masafumi
    Department of Pediatric Surgery, Nara Hospital, Kinki University School of Medicine
  • Morisita Yuji
    Department of Pediatric Surgery, Nara Hospital, Kinki University School of Medicine
  • Yonekura Takeo
    Department of Pediatric Surgery, Nara Hospital, Kinki University School of Medicine

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Other Title
  • Bianchi 法による食道閉鎖根治術の検討
  • Bianchiホウ ニ ヨル ショクドウ ヘイサ コンジジュツ ノ ケントウ

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Abstract

Purpose: The axillary skin crease incision (“Bianchi method”) has been our first choice of surgery for esophageal atresia (EA) since 2001. We herein retrospectively investigated the usefulness of and issues associated with this method in patients with long-gap and short-gap EA.<br>Methods: All 16 patients have undergone radical operation for type-C EA with the Bianchi method since 2001. We divided these patients into the following two groups: patients with a gap of ≥20-mm between the upper and lower ends of the esophagus (long-gap group: LG, n = 4), and patients with a gap of <20-mm (short-gap group: SG, n = 12). We then retrospectively compared the associated malformations, operative procedure, operative time and postoperative complications between groups.<br>Results: The percentages of patients who had associated malformations other than EA were 42% and 50% in the SG and LG groups, resoectively. The mean operative time, which included the time for intraoperative bronchoscopic examination, was 219.2 ± 49.7 min for SG and 291.3 ± 51.4 min for LG patients. Postoperative complications comprising recurrent tracheoesophageal fistula (TEF) and anastomotic stricture associated with anastomotic leaks were found in one patient each in SG patients (2/12, 17%). In the LG group, two patients developed anastomotic leaks and one experienced recurrent TEF (3/4, 75%).<br>Conclusion: LG patients had longer operative time and more complications than SG patients. Poor field of view was considered as a factor contributing to this result. Therefore, patients with long-gap EA should undergo thoracotomy in the fifth or sixth intercostal space, or should be treated using a combination procedure with a thoracoscope to secure a good operating field.

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