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- W2042642114 abstract "Introduction: In long gap esophageal atresia (EA) when most of the intrathoracic esophagus is missing, an initial primary repair is not possible. Common solutions of gastric and colon interpositions, unfortunately, bring many undesirable consequences. The ability to rapidly grow the esophagus, however, could have lasting benefit. Our initial hypothesis was that, rather than being genetic in origin, the deficiency was developmental. Consequently, we also proposed that axial tension would provide the signal for growth. The purpose of this study was to determine if tension induced true growth, rather than stretching, and would make primary repair possible. Methods: Thirty-one long-gap (3.1-10.6 cm) EA patients underwent a growth procedure using external traction on the esophageal segments, all resulting in a true primary repair. Pre-operative and post-repair x-ray studies (esophagrams) were analyzed and the lengths of the upper and lower segments calculated. Wall width was determined by ultrasonography (2.2 mm) and segmental volume and mass was then calculated from a cylindrical model. Pre- and post-operative data for each segment were compared. Results: For all 31 infants, a true primary anastomosis was completed in 12.9 +/−7 days. The considerable variation in initial gap lengths gave a wide range of growth. The increase in tissue mass gave the best indication of growth, and the upper segment average increased from 2.0 gm to 3.9 gm, a percent increase of 193% (3-1251%). The average lower segment mass increased from 1.0 gm to 2.9 gm. The small initial size of some lower segments led to a very wide range of increases in mass (52-8475%). Conclusions: Catch-up growth of very small segments can be induced by axial tension and accomplish in days what would normally take months in the fetus and the infant. Axial tension presumably provides a signal which mimics in accelerated fashion that provided by normal skeletal growth. The ability to induce catch-up growth makes a primary repair using their own esophagus possible in all EA infants. Primary repair should have increasing benefits and make the goal of 70 good years possible." @default.
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- W2042642114 date "2008-02-01" @default.
- W2042642114 modified "2023-09-27" @default.
- W2042642114 title "QS146. Growth Induction - A Biological Solution to Long Gap Esophageal Atresia" @default.
- W2042642114 doi "https://doi.org/10.1016/j.jss.2007.12.387" @default.
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