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Tobia A, Luque CG, Leitmeyer K, Dorling M, Chadha NK. Endoscopic treatment in pediatric patients with recurrent and H-type tracheoesophageal fistulas - A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2023; 168:111541. [PMID: 37043961 DOI: 10.1016/j.ijporl.2023.111541] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES Endoscopic treatments for managing recurrent tracheoesophageal fistula (rTEF) and H-type TEF are being utilized lately; however, the preferred technique is yet to be determined. We aimed to systematically review existing publications on endoscopic treatment of rTEF and H-type TEF to analyze their success and complication rates. METHODS PRISMA guidelines were followed. MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials were comprehensively searched in accordance to a priori developed protocol, from 1975 until 2020. English, Spanish and German papers were included. Studies were independently screened and analyzed by two reviewers. RESULTS 84 full texts were assessed for eligibility out of 581 screened studies, of these, 39 studies with 127 patients were eligible for inclusion (115 rTEF and 12 H-type TEF). All included studies were cases reports or case series. Overall success rate was 45% with sealant injection, 87% with de-epithelialization and 80% with sealant injection and de-epithelialization combined. The mean number of required treatments for success was 1.9 (range 1-6). Mixed effect model meta-analysis of case series with n > 1 showed that sealant injection had a significantly lower success rate of 50% (95% CI 1-99%, I2 72%) compared to de-epithelialization 90% (95% CI 72-99%, I2 27%), p = 0.007 and the combination of both techniques 87% (95% CI 68-99%, I2 11%), p = 0.02. Nine patients (7%) had transient respiratory distress. No mortalities reported. CONCLUSION Endoscopic treatment for rTEF and H-type fistula is a minimally invasive technique with favorable outcome and considerably less morbidity compared to open surgery, suggesting it as a safe and effective first line treatment option. Repeated endoscopic treatment attempts can be expected to obtain complete closure. De-epithelization techniques with or without combined tissue adhesive injection had significantly better results than sealant injection techniques alone.
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Affiliation(s)
- Amjad Tobia
- Division of Pediatric Otolaryngology-Head & Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Carolina Grau Luque
- Division of Pediatric Otolaryngology-Head & Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Otolaryngology, Head and Neck Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Katharina Leitmeyer
- Division of Pediatric Otolaryngology-Head & Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Division of Pediatric Otolaryngology-Head & Neck Surgery, University Children's Hospital of Basel, Basel, Switzerland
| | - Marisa Dorling
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neil K Chadha
- Division of Pediatric Otolaryngology-Head & Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Yokota N, Ishibashi H, Suga K, Mori H, Kitamura A, Nakagawa R, Shimada M. A case of Gross E esophageal atresia discovered following a unique clinical course. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:141-144. [PMID: 35466136 DOI: 10.2152/jmi.69.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The patient was a 15 months-old boy who had been diagnosed CHARGE syndrome, which is a multiple congenital anomaly syndrome caused by mutations in the CHD7 gene. Mechanical ventilation management was initiated 2 hours after birth for dysphagia and respiratory failure, and tracheotomy was performed 3 months after birth for dysphagia and failed extubation. He was repeatedly hospitalized due to pneuomoniae. Approximately 1 year after birth, the boy had two consecutive episodes of sudden ventilatory insufficiency while replacing the tracheotomy cannula. A bronchoscopic examination under general anesthesia revealed a tracheoesophageal fistula directly below the tracheostomy. The patient was diagnosed with Gross E esophageal atresia, and we speculated that the cannula migrated to the esophagus via the fistula during tracheostomy cannula replacement. Gross E esophageal atresia is a rare disease. Its diagnosis is often delayed, and it is discovered by recurrent pneumonia in many cases. A tracheoesophageal fistula may also be found in children with deformities of the respiratory system. Furthermore, tracheoesophageal fistulae are often found in the neck. Therefore, when sudden ventilatory insufficiency occurs in a child with a tracheostomy after replacing the tracheostomy cannula, caution must be exercised since the cannula may have migrated to the esophagus via a fistula. J. Med. Invest. 69 : 141-144, February, 2022.
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Affiliation(s)
- Noriko Yokota
- Department of Pediatric and Pediatric Endoscopic Surgery, Tokushima University, Tokushima, Japan
| | - Hiroki Ishibashi
- Department of Pediatric and Pediatric Endoscopic Surgery, Tokushima University, Tokushima, Japan
| | - Kenichi Suga
- Department of Pediatrics, Tokushima University, Tokushima, Japan
| | - Hiroki Mori
- Department of Pediatric and Pediatric Endoscopic Surgery, Tokushima University, Tokushima, Japan
| | - Akiko Kitamura
- Department of Pediatrics, Tokushima University, Tokushima, Japan
| | - Ryuji Nakagawa
- Department of Pediatrics, Tokushima University, Tokushima, Japan
| | - Mitsuo Shimada
- Department of Pediatric and Pediatric Endoscopic Surgery, Tokushima University, Tokushima, Japan
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Yang S, Li S, Yang Z, Liao J, Hua K, Zhang Y, Zhao Y, Gu Y, Li S, Huang J. Risk Factors for Recurrent Tracheoesophageal Fistula After Gross Type C Esophageal Atresia Repair. Front Pediatr 2021; 9:645511. [PMID: 34055687 PMCID: PMC8155366 DOI: 10.3389/fped.2021.645511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To determine the possible risk factors of recurrent tracheoesophageal fistula (rTEF) after Gross type C esophageal atresia (EA) and tracheoesophageal fistula (TEF) repair. Methods: The medical records of 343 pediatric patients with Gross type C EA/TEF who underwent surgical repair were retrospectively analyzed. The patients were retrospectively divided into two groups according to whether they had rTEF. Univariate and multivariable logistic regression analysis were performed to identify risk factors for rTEF. Results: After the diagnosis of EA/TEF, 343 patients (221 boys) underwent primary repairs after birth. According to the follow-up results (257 patients survived, 42 died, and 43 were lost to follow-up), 259 patients (257 survived and two died after rTEF repair) were included in the analysis. rTEF occurred in 33 patients (33/259, 12.74%), with a median onset time to recurrence of 3.8 (2.2, 8.2) months. Multivariate analysis showed that closing the original TEF with ligation and hospital stay ≥ 28.5 days were significant risk factors of rTEF with OR of 4.083 (1.481, 11.261) and 3.228 (1.431, 7.282). Conclusions: Surgical closure technique of original TEF and the length of initial stay could influence the occurrence of rTEF after Gross type C EA/TEF repair.
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Affiliation(s)
- Shen Yang
- National Center for Children's Health, Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Siqi Li
- National Center for Children's Health, Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Zhi Yang
- Department of Neonatal Surgery, The Affiliated Children's Hospital of Nanchang University, Nanchang, China
| | - Junmin Liao
- National Center for Children's Health, Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Kaiyun Hua
- National Center for Children's Health, Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yanan Zhang
- National Center for Children's Health, Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yong Zhao
- National Center for Children's Health, Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yichao Gu
- National Center for Children's Health, Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Shuangshuang Li
- National Center for Children's Health, Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jinshi Huang
- National Center for Children's Health, Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, China.,Department of Neonatal Surgery, The Affiliated Children's Hospital of Nanchang University, Nanchang, China
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Hua K, Yang S, Zhang Y, Zhao Y, Gu Y, Li S, Liao J, Huang J. Thoracoscopic surgery for recurrent tracheoesophageal fistula after esophageal atresia repair. Dis Esophagus 2020; 33:5823895. [PMID: 32322874 DOI: 10.1093/dote/doaa023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/08/2020] [Accepted: 03/31/2020] [Indexed: 12/11/2022]
Abstract
We aimed to investigate the safety, feasibility, and outcomes of thoracoscopic surgery for recurrent tracheoesophageal fistula (rTEF) after esophageal atresia repair. The medical records and follow-up data of 31 patients who underwent thoracoscopic surgery for rTEF at a single institution were collected and reviewed. In total, 31 patients were enrolled with a median age of 7 months (range: 3-30 months) and a median weight of 6,000 g (range: 4,000-12,000 g) before reoperation. The median operation time for the entire series was 2.9 hours (range: 1.5-7.5 hours), and the median total hospitalization duration after surgery was 19 days (range: 11-104 days). One patient died of anastomotic leakage, a second rTEF, severe malnutrition, and thoracic infection; the mortality rate was 3.23% (1/31). Nine patients (9/31, 29.03%) had an uneventful recovery, and the incidences of postoperative anastomotic leakage, anastomotic stricture, and second rTEF were 25.81%, 61.29%, and 9.68%, respectively. After a median follow-up of 12 months (range: 3-24 months), 26 survivors resumed full oral feeding, 2 were tube fed, 2 required a combination of methods, and 4 patients experienced severe respiratory complications. In total, 9 patients had pathological gastroesophageal reflux, and 2 patients eventually underwent Nissen fundoplication. Of the 30 survivors with growth chart data, the median weight for age Z-score, height for age Z-score, and weight for height Z-score were - 0.46 (range: -5.1 to 2.8), 0.75 (range: -2.7 to 4.7), and - 1.14 (range: -6.8 to 3.0), respectively. Thoracoscopic surgical repair for rTEF is safe, feasible, and effective with acceptable mortality and morbidity.
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Affiliation(s)
- Kaiyun Hua
- Department of Neonatal Surgery, Beijing Children Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shen Yang
- Department of Neonatal Surgery, Beijing Children Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yanan Zhang
- Department of Neonatal Surgery, Beijing Children Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yong Zhao
- Department of Neonatal Surgery, Beijing Children Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yichao Gu
- Department of Neonatal Surgery, Beijing Children Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shuangshuang Li
- Department of Neonatal Surgery, Beijing Children Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Junmin Liao
- Department of Neonatal Surgery, Beijing Children Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jinshi Huang
- Department of Neonatal Surgery, Beijing Children Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Dokumcu Z, Polatdemir K, Ozcan C, Erdener A. Postoperative recurrent tracheoesophageal fistula: an unusual complication of oxidized regenerated cellulose (Surgicel®). Int J Pediatr Otorhinolaryngol 2014; 78:701-3. [PMID: 24576454 DOI: 10.1016/j.ijporl.2014.01.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 01/23/2014] [Accepted: 01/26/2014] [Indexed: 10/25/2022]
Abstract
Oxidized regenerated cellulose (Surgicel(®)) is a commonly used material in Pediatric Surgery. We present a case of recurrent tracheoesophageal fistula (RTEF) repaired by Surgicel(®). In this case, tracheoesophageal fistula (TEF) recurred due to migration of Surgicel into the tracheal and esophageal lumen.
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Affiliation(s)
- Zafer Dokumcu
- Department of Pediatric Surgery, Ege University Facuty of Medicine, 35100 Bornova, Izmir, Turkey.
| | - Kamer Polatdemir
- Department of Pediatric Surgery, Ege University Facuty of Medicine, 35100 Bornova, Izmir, Turkey
| | - Coskun Ozcan
- Department of Pediatric Surgery, Ege University Facuty of Medicine, 35100 Bornova, Izmir, Turkey
| | - Ata Erdener
- Department of Pediatric Surgery, Ege University Facuty of Medicine, 35100 Bornova, Izmir, Turkey
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