The novel application of an emerging device for salvage of primary repair in high-risk complex esophageal atresia

Introduction: Preservation of native esophagus is a tenet of esophageal atresia (EA) repair. However, tech-niques for delayed primary anastomosis are severely limited for surgically and medically complex pa-tients at high-risk for operative repair. We report our initial experience with the novel application of the Connect-EA, an esophageal magnetic compression anastomosis device, for salvage of primary repair in 2 high-risk complex EA patients. Compassionate use was approved by the FDA and treating institutions. Operative Technique: Two approaches using the Connect-EA are described - a totally endoscopic approach and a novel hybrid operative approach. To our knowledge, this is the first successful use of a hybrid operative approach with an esophageal magnetic compression device. Outcomes: Salvage of delayed primary anastomosis was successful in both patients. The totally endo-scopic approach significantly reduced operative time and avoided repeat high-risk operation. The hybrid operative approach salvaged delayed primary anastomosis and avoided cervical esophagostomy. Conclusion: The Connect-EA is a novel intervention to achieve delayed primary esophageal repair in com-plex EA patients with high-risk tissue characteristics and multi-system comorbidities that limit operative repair. We propose a clinical algorithm for use of the totally endoscopic approach and hybrid operative approach for use of the Connect-EA in high-risk complex EA patients.(c) 2022 Elsevier Inc. All rights reserved.

Automated summary

This study reports the initial experience of using the Connect-EA, an esophageal magnetic compression anastomosis device, for salvage of primary repair in two high-risk complex esophageal atresia (EA) patients. Two approaches, totally endoscopic and hybrid operative, were successfully employed. The Connect-EA offers a novel intervention for delayed primary esophageal repair in complex EA patients, who have high-risk tissue characteristics and multi-system comorbidities that limit operative repair.