Darius Patkowski

37 statements · 1 topic

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I am very strict about the definition of long gap. OK. Long gap, it's just only type A and B. It's my definition, of course, many people agree with them because if you say that type C is a long gap, it's quite a different story.
quote · Long-gap Esophageal Atresia
The technique was designed to bridge the gap between the esophageal pouches of long gap esophageal essia, which for me means type A and B, using stage thorachoscopic approach.
quote · Long-gap Esophageal Atresia

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Darius's statements about Long-gap Esophageal Atresia 37 statements

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Dariusz Patkowski, MD, PhD - Best of the Best in Pediatric Surgery 2024

Quotation The technique was designed to bridge the gap between the esophageal pouches of long gap esophageal essia, which for me means type A and B, using stage thorachoscopic approach. Open
Statement The technique was designed to bridge the gap between esophageal pouches of long-gap esophageal atresia, which for the presenter means type A and B, using staged thoracoscopic approach. Open
Statement All 27 cases of long-gap esophageal atresia were operated thoracoscopically. Open
Statement Both ends of the esophagus are brought together under tension with internal traction suture using static, not active tension. Open
Quotation Both ends of the esophagus are brought together under tension with internal traction suture. This is a static, not active tension. Open
Statement Preoperative rigid bronchoscopy is a standard procedure to check for upper fistula and any tracheal malformation. Open
Statement The patient lies in prone position on the edge of the operating table with the right scapula as the anatomical reference point for trocar placement. Open
Quotation There is no need to use electrosurgery. Open
Statement There is no need to use electrosurgery for dissection of the esophageal pouches and fistula. Open
Statement For internal traction, a 2-0 non-absorbable braided suture is used. Open
Quotation For internal traction, we use a 20 non-absorbable braided suture. Open
Statement Clips are placed to cover the entire thickness of the tissue and part of the suture to prevent leaks and allow greater force for traction. Open
Quotation There's no need to rush. Time is needed for the tissue to stretch. Wait a moment. Open
Statement Subsequent stages are performed every 1 to 5 days. Open
Quotation There is no need for a gastrostomy. The patient remains intubated in the intensive care unit on parenteral nutrition. We don't use chest drainage. Open
Statement There is no need for a gastrostomy with this technique. Open
Statement The patient remains intubated in the intensive care unit on parenteral nutrition between stages. Open
Statement Chest drainage is not used with this technique. Open
Quotation I am personally against suction with the repro tube, as it dries the mucosa, in my opinion. I prefer intermittent suction on demand. Open
Statement The presenter is personally against suction with the Replogle tube as it dries the mucosa, preferring intermittent suction on demand. Open
Statement Anastomosis is possible if both ends overlap, but care must be taken when deciding as there is no way back and any failure will result in loss of part of the esophagus. Open
Quotation Anastomosis is possible if both ends overlap, but care must be taken when deciding. There is no way back. Any failure will result in the loss of part of the esophagus. Open
Statement If anastomosis is not possible, the sliding knots can be reopened and used again to bring pouches closer together. Open
Statement The thoracoscopic internal traction technique was used in 25 cases of long-gap esophageal atresia and completed with anastomosis in 23 cases. Open
Statement Most cases were completed in 2 stages, but there were also 2 cases operated on in 5 and 6 stages. Open
Statement Initially, the time between stages was about 4 weeks, but this was reduced to a few days. Open
Statement With current experience, if there is any tension even when pouches overlap, the presenter would connect them with one suture and leave it for 2 or 3 days more before completing anastomosis. Open
Statement In the last series of 9 primary cases without gastrostomy, the average hospital stay was 31 days. Open
Statement One gastric pull-up complication occurred and was later successfully treated laparoscopically. Open
Statement The presenter strictly defines long-gap as only type A and B esophageal atresia, not type C. Open
Quotation I am very strict about the definition of long gap. OK. Long gap, it's just only type A and B. It's my definition, of course, many people agree with them because if you say that type C is a long gap, it's quite a different story. Open
Statement In the presenter's experience, type C esophageal atresia was always possible to make primary anastomosis, with the only exception being when the patient was unstable. Open
Quotation You just open it. If you are very familiar with the sliding note, yeah, you locked it, blocked it, then you can reopen it. So I use the same, OK, I use every time I entered the chest again, I use the same sliding notes. You unlock it. Open
Statement The same sliding knots can be unlocked and reused at each subsequent operation rather than placing new sutures. Open
Statement When unlocking a sliding knot, one end is a little bit longer and the other end is a little bit shorter; the long one goes up and the short one goes down. Open
Quotation That's my quotation, that sliding knot changed my surgical life. Open
Statement Peter Chaudderna showed the presenter how to do the sliding knot at the IPEC meeting in 2005 in Venice. Open