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Ishikawa M, Tomita H, Ito Y, Tsukizaki A, Abe K, Shimotakahara A, Shimojima N, Hirobe S. Analysis of gap length as a predictor of surgical outcomes in esophageal atresia with distal fistula: a single center experience. Pediatr Surg Int 2024; 40:99. [PMID: 38581456 DOI: 10.1007/s00383-024-05678-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE Long-gap esophageal atresia (LGEA) is still a challenge for pediatric surgery. No consensus exists as to what constitutes a long gap, and few studies have investigated the maximum gap length safely repairable by primary anastomosis. Based on surgical outcomes at a single institution, we aimed to determine the gap length in LGEA with a high risk of complications. METHODS The medical records of 51, consecutive patients with esophageal atresia (EA) with primary repair in the early neonatal period between 2001 and 2021 were retrospectively reviewed. Three, major complications were found in the surgical outcomes: (1) anastomotic leakage, (2) esophageal stricture requiring dilatation, and (3) GERD requiring fundoplication. The predictive power of the postsurgical complications was assessed using receiver operating characteristic analysis, and the area under the curve (AUC) and the cutoff value with a specificity of > 90% were calculated. RESULTS Sixteen patients (31.4%) experienced a complication. The AUC of gap length was0.90 (p < 0.001), and the gap length cutoff value was ≥ 2.0 cm for predicting any complication (sensitivity: 62.5%, specificity: 91.4%). CONCLUSION A gap length ≥ 2.0 cm was considered as defining LGEA and was associated with an extremely high complication rate after primary repair.
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Affiliation(s)
- Miki Ishikawa
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan.
| | - Hirofumi Tomita
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Yoshifumi Ito
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Ayano Tsukizaki
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Kiyotomo Abe
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Akihiro Shimotakahara
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Naoki Shimojima
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Seiichi Hirobe
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
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Dimitrov G, Aumar M, Duhamel A, Wanneveich M, Gottrand F. Proton pump inhibitors in esophageal atresia: A systematic review and meta-analysis. J Pediatr Gastroenterol Nutr 2024; 78:457-470. [PMID: 38262739 DOI: 10.1002/jpn3.12115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/09/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
Gastroesophageal reflux disease (GERD) is frequent and prolonged in esophageal atresia (EA) pediatric patients requiring routine use of proton pump inhibitors (PPIs). However, there are still controversies on the prophylactic use of PPIs and the efficacy of PPIs on GERD and EA complications in this special condition. The aim of the study is to assess the prophylactic use of PPIs in pediatric patients with EA and its complications. We, therefore, performed a systematic review including all reports on the subject from 1980 to 2022. We conducted meta-analysis of the pooled proportion of PPI-and no PPI groups using random effect model, meta-regression, and estimate heterogeneity by heterogeneity index I2 . Thirty-eight reports on the topic met the criteria selection, representing a cumulative 6044 patients with EA. Prophylactic PPI prescription during the first year of life does not appear to prevent GERD persistence at follow-up and is not associated with a significantly reduced rate of antireflux surgical procedures (ARP). PPIs improve peptic esophagitis and induce remission of eosinophilic esophagitis at a rate of 50%. Their effect on other GERD outcomes is uncertain. Evidence suggests that PPIs do not prevent anastomotic stricture, Barrett's esophagus, or respiratory complications. PPI use in EA can improve peptic and eosinophilic esophagitis but is ineffective on the other EA complications. Side effects of PPIs in EA are almost unknown.
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Affiliation(s)
- Georges Dimitrov
- Unit of Pediatric Surgery, Unit of Pediatrics, Competence Centre for Rare Esophageal Diseases, University Hospital Center of Orléans, Orléans, France
| | - Madeleine Aumar
- Reference Centre for Rare Esophageal Diseases, University of Lille, CHU Lille, Lille, France
| | - Alain Duhamel
- Biostatistics Unit, University Hospital of Lille, Lille, France
| | | | - Frédéric Gottrand
- Reference Centre for Rare Esophageal Diseases, University of Lille, CHU Lille, Lille, France
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Li H, Yan L, Ju R, Li B. Detection of H-type bronchoesophageal fistula in a newborn: A case report and literature review. Medicine (Baltimore) 2022; 101:e25251. [PMID: 35212268 PMCID: PMC8878874 DOI: 10.1097/md.0000000000025251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/04/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Congenital tracheoesophageal fistula (TEF) is a rare developmental malformation. The H subtype accounts for approximately 4% of TEFs. Unlike other TEFs, the H-type is not accompanied by esophageal atresia and has nonspecific clinical symptoms, and its specific anatomical abnormalities are not always readily apparent. Furthermore, none of the currently available diagnostic methods for H-type TEF have absolute sensitivity, resulting in misdiagnoses, and accurate diagnoses are often delayed even until adulthood; in our case, we detected a congenital bronchoesophageal fistula, which is even more rare than regular H-type TEF, through a technique that was not previously reported for newborns, involving bronchoscopy, with methylene blue injected through an esophagoscope. We believe that we have provided this kind of case first in newborns.Furthermore, because there is not one literature summarizing the clinical symptoms and the effective methods up to now, we still are not clear which detective method is more efficient or accurate, especially in newborns, so it is very necessary to summarize and compare for improving the early diagnosis of TEFs; our study makes a significant contribution to the literature because we collated previously reported cases, including the clinical features and the usefulness and success rates of major tests, which will be very helpful for the early diagnosis of TEFs. PATIENT CONCERNS A newborn male presented with an array of nonspecific clinical symptoms from birth, leading to pneumonia and mechanical ventilation. Oral feeding led to an improvement in most but not all symptoms, which returned when oral feeding was resumed. A second round of confirmatory tests was still unable to detect the cause. DIAGNOSIS The diagnosis of H-type bronchoesophageal fistula was established through a technique that was not previously reported for newborns, involving bronchoscopy, with methylene blue injected through an esophagoscope. INTERVENTIONS The surgery was performed after diagnosis, and the bronchoesophageal fistula was successfully repaired. OUTCOMES The patient was discharged on postoperative day 7, and his status was reported to be normal at a follow-up visit 8 months after surgery. LESSONS H-type TEF is a rare congenital abnormality, and its early diagnosis is highly difficult, especially bronchoesophageal fistula. Increased oral saliva and air-filled stomachs are characteristic manifestations. Bronchoscopy combined with esophagoscopy can improve the rate of early diagnosis. A combination of tests can improve the detection rate.
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Affiliation(s)
- Huaying Li
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Yan
- Department of Respiration Center, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, People's Republic of China
| | - Rong Ju
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Biao Li
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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LaRusso K, Joharifard S, Lakabi R, Nimer N, Shahi A, Kasasni SM, Lévesque D, Moreau B, Aspirot A, Laberge JM, Faure C, Emil S. Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula: The Quebec experience. J Pediatr Surg 2022; 57:41-44. [PMID: 34666898 DOI: 10.1016/j.jpedsurg.2021.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 09/08/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE Recent studies have identified transanastomotic tubes (TATs) as a risk factor for the development of anastomotic strictures after repair of esophageal atresia with tracheoesophageal fistula (EATEF). We further investigated these findings in a multicenter study. METHODS We conducted a retrospective cohort study at three university-affiliated hospitals in the province of Quebec. All patients with types C and D EATEF who underwent primary repair between January 1993 and August 2018 were included. Anastomotic stricture was defined as clinical symptoms of stricture with confirmation on esophagram or endoscopy. Multivariate logistic regression and the Wilcoxon Rank-Sum test were used to evaluate the primary outcome of stricture within one year of surgery and secondary outcome of duration of postoperative total parenteral nutrition (TPN). RESULTS 244 patients were included, of which 234 (96%) were type C and 10 (4%) were type D. The anastomotic stricture rate at 1 year was 30%. TATs were utilized in 61% of patients. Thirty-six percent of patients with TATs developed a stricture within one year, as compared to 19% of patients without TATs (p = 0.005). TATs were associated with stricture on univariate analysis (OR 2.49, p = 0.004, 95% CI: 1.37-4.69). On multivariate analysis, after adjusting for gestational age, birth weight, leak, long gap, anastomotic tension, and daily acid suppression, patients with TATs had 2.72 times higher odds of developing a stricture as compared to patients without TATs (p = 0.006, 95% CI: 1.35-5.74). The median duration of TPN was 9 days in both groups (p = 0.139, IQR 6-14 in patients with TATs versus IQR 7-16 in patients without). CONCLUSION Transanastomotic tubes are associated with a significantly higher risk of postoperative stricture following repair of esophageal atresia with tracheoesophageal fistula and do not shorten the duration of total parenteral nutrition. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kathryn LaRusso
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Boulevard, Room B04.2028, Montreal, QC H4A 3J1, Canada
| | - Shahrzad Joharifard
- Division of Pediatric General and Thoracic Surgery, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montreal, QC, Canada
| | - Rosa Lakabi
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Boulevard, Room B04.2028, Montreal, QC H4A 3J1, Canada
| | - Nancy Nimer
- Division of Pediatric General and Thoracic Surgery, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montreal, QC, Canada
| | - Amirali Shahi
- Division of Pediatric General and Thoracic Surgery, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montreal, QC, Canada
| | - Sara Medina Kasasni
- Department of Pediatrics, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Dominique Lévesque
- Division of Pediatric Gastroenterology, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Brigitte Moreau
- Department of Pediatrics, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Ann Aspirot
- Division of Pediatric General and Thoracic Surgery, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montreal, QC, Canada
| | - Jean-Martin Laberge
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Boulevard, Room B04.2028, Montreal, QC H4A 3J1, Canada
| | - Christophe Faure
- Division of Pediatric Gastroenterology, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montreal, QC, Canada
| | - Sherif Emil
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Boulevard, Room B04.2028, Montreal, QC H4A 3J1, Canada.
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Hew NLC, Grover Z, Paida S, Gera S, Effendy RZT, Kikiros C, Gera P. Predictors of poor outcomes in children with tracheoesophageal fistula/oesophageal atresia: an Australian experience. World Jnl Ped Surgery 2021; 4:e000190. [DOI: 10.1136/wjps-2020-000190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 11/03/2022] Open
Abstract
ObjectiveThe aim of this study is to characterize long-term morbidities of oesophageal atresia (OA) with or without tracheoesophageal fistula (TOF).MethodsInfants born with OA/TOF from 2000 to 2016 in Western Australia were included for analysis. Infants were categorized into high-risk and low-risk groups based on the presence of one or more perioperative risk factors [low birth weight, vertebraldefects, anal atresia, cardiac defects, TOF, renalanomalies, limb abnormalities (VACTERL), anastomotic leak, long gap OA, and failure to establish oral feeds within the first month] identified by a previous Canadian study. Frequency of morbidities in infants with perioperative risk factors was compared.ResultsOf 102 patients, 88 (86%) had OA with distal TOF (type C). The most common morbidities in our cohort were anastomotic oesophageal strictures (AS) (n=53, 52%), tracheomalacia (n=48, 47%), gastroesophageal reflux disease (GORD) (n=42, 41%) and recurrent respiratory tract infections (n=40, 39%). Presence of GORD (30/59 vs 12/43, p=0.04) and median frequency of AS dilatations (8 vs 3, n=59, p=0.03) were greater in the high-risk group. This study further confirmed that inability to be fed orally within the first month was associated with high morbidities.ConclusionsGastrointestinal and respiratory morbidities remain high in OA/TOF regardless of perioperative risk factors. Inability to be fed orally within the first month is a predictor of poor outcomes with high frequency of gastrointestinal and respiratory comorbidities.
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Abstract
BACKGROUND H type tracheoesophageal fistula (H-TEF) is a rare congenital anomaly. Management may be complicated by late diagnosis and variation(s) in the therapeutic strategy. A systematic review of published studies explores the utility of diagnostic studies, operations and postoperative complications. METHODS Medline and PubMed database(s) were searched for ALL studies reporting H-TEF during 1997-2020. Using PRISMA methodology, manuscripts were screened for eligibility and reporting. RESULTS Forty-seven eligible studies were analysed. Primary diagnosis varied widely with surgeons performing oesophagography and trachea-bronchoscopy. Preoperative localisation techniques included fluoroscopy, guidewire placement and catheterisation. A cervical approach (209 of 272 cases), as well as thoracotomy, thoracoscopy and endoscopic fistula ligation, were all described. Morbidity included fistula recurrence (1.7%), leak (2%), tracheomalacia (3.4%) and respiratory sequelae (1%). The major adverse complication in all studies was vocal cord palsy secondary to laryngeal nerve injury (18.5%) yet strikingly few centres routinely reported undertaking vocal cord screening pre or postoperatively. CONCLUSION This study shows that paediatric surgeons record low volume activity with H type tracheoesophageal fistula. Variation(s) in clinical practice are widely evident. Laryngeal nerve injury and its subsequent management warrant special consideration. Care pathways may offset attendant morbidity and define 'best practice.'
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Affiliation(s)
- Keerthika Sampat
- Department of Paediatric Surgery, Alder Hey Childrens’ Hospital, Liverpool, UK
| | - Paul D. Losty
- Department of Paediatric Surgery, Alder Hey Childrens’ Hospital, Liverpool, UK ,Institute of Child Health, School of Health And Life Science, University of Liverpool, Liverpool, UK
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Quick ME, Giblett N, Uwiera TC, Herbert H, Vijayasekaran S. A novel approach in managing challenging tracheoesophageal fistulae. Int J Pediatr Otorhinolaryngol 2020; 138:110261. [PMID: 32798829 DOI: 10.1016/j.ijporl.2020.110261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyze the outcomes of an open anterior cervical approach and tospecifically describe a novel extended tracheotomy incision ("Key-hole technique") torepair H-type and other challenging tracheoesophageal fistulae (TOF) at a singletertiary pediatric center. METHOD A retrospective chart analysis of pediatric patients (0-18 years old) who had undergone repair of TOF's between January 2006 and March 2020 were reviewed. A case series of patients who had undergone open cervical utilizing three different techniques were included. Patient demographics, surgical management and post-operative surgical outcomes including complications were evaluated. RESULTS During the study period, 117 pediatric patients were diagnosed and anaged with TOFs with or without oesophageal atresia. Within this group, 12 patients (10%) had anterior open cervical repair of congenital or persisting TOFs (6 males and 6 females). Eight cases (7%) had congenital Type E (known as H-type), two had type D, one type B and one type C TOF. Median gestational age was 37 weeks (range 28-41 weeks), age of presentation ranged from 1 day old to 3 years old with 67% being diagnosed within the first month of life. At the time of definitive surgery all patients had a bronchoscopy and oesophagoscopy to confirm the diagnosis, identify the level of the fistula and place a catheter through the fistula. This cases series of open anterior cervical repair of TOFs comprised of seven (58%) patients who had primary extraluminal tracheal approach, four (33%) with extended tracheotomy incision ('Key-hole' technique) and one (9%) patient with slide tracheoplasty for recurrent type C TOF in the presence of subglottic stenosis. Eleven of the twelve patients had successful open anterior cervical repair of TOF. One patient who had primary open anterior cervical repair with the 'Key-hole' technique had recurrence managed successfully with slide tracheoplasty. There were no cases of recurrent laryngeal nerve injury. CONCLUSION This series demonstrates that open anterior cervical approach to correct TOFs is an effective and safe method in the majority of cases of congenital and acquired fistulae where there is no oesophageal atresia or the atresia is corrected (in the case of recurrent or second fistulae). We also present the outcomes of a novel surgical "Keyhole" technique to manage TOF fistulas via an extended-tracheotomy incision. We also found that slide tracheoplasty is an effective salvage operation in the case of complex recurrent fistulae.
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Affiliation(s)
- Mark E Quick
- Department of Otolaryngology, Perth Children's Hospital, Nedlands, WA, Australia.
| | - Neil Giblett
- Department of Otolaryngology, Perth Children's Hospital, Nedlands, WA, Australia
| | - Trina C Uwiera
- Division of Pediatric Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hayley Herbert
- Department of Otolaryngology, Perth Children's Hospital, Nedlands, WA, Australia
| | - Shyan Vijayasekaran
- Department of Otolaryngology, Perth Children's Hospital, Nedlands, WA, Australia; Faculty of Health and Medical Sciences, University of Western Australia, WA, Australia
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Ngo PD, Kamran A, Clark SJ, Jennings RW, Hamilton TE, Smithers CJ, Zendejas B, Yasuda JL, Zurakowski D, Manfredi MA. Intralesional Steroid Injection Therapy for Esophageal Anastomotic Stricture Following Esophageal Atresia Repair. J Pediatr Gastroenterol Nutr 2020; 70:462-7. [PMID: 31764412 DOI: 10.1097/MPG.0000000000002562] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The role of intralesional steroid injection (ISI) in the treatment of anastomotic stricture in patients with esophageal atresia remains unclear. The aim of this study was to evaluate the efficacy and safety of ISI. METHODS A total of 158 patients with esophageal atresia with at least 1 ISI for the treatment of esophageal anastomotic stricture between 2010 and 2017 were identified. The change in stricture diameter (ΔD) was compared between procedures with dilation alone (ISI-) and dilation with steroid injection (ISI+). RESULTS A total of 1055 balloon dilations were performed (452 ISI+). The median ΔD was significantly greater in the ISI+ group: 1 mm (interquartile range [IQR] 0, 3) versus 0 mm (IQR -1, 1.5) (P < 0.0001). The ISI+ group had greater percentage of improved diameter (P < 0.0001) and lesser percentages of unchanged and decreased diameters at subsequent endoscopy (P = 0.0009, P = 0.003). Multivariable logistic regression confirmed the significance of ISI on increasing the likelihood of improved stricture diameter with an adjusted odds ratio of 3.24 (95% confidence interval: 2.15-4.88) (P < 0.001). The ΔD for the first 3 ISI+ procedures was greater than the ΔD for subsequent ISI+ procedures: 1 mm (IQR 0, 3) versus 0.5 mm (IQR-1.25, 2) (P = 0.001). There was no difference in perforation incidence between ISI+ and ISI- groups (P = 0.82). CONCLUSIONS ISI with dilation was well tolerated and improved anastomotic stricture diameter more than dilation alone. The benefit of ISI over dilation alone was limited to the first 3 ISI procedures.
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Glenn T, Kim Mackow A, Shivapour J, Crowley M. Case 1: Acute Respiratory Failure in a 1-month-old Girl. Pediatr Rev 2019; 40:590-592. [PMID: 31676532 DOI: 10.1542/pir.2017-0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Anne Kim Mackow
- Department of Pediatric Surgery, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH
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Baird R, Lal DR, Ricca RL, Diefenbach KA, Downard CD, Shelton J, Sømme S, Grabowski J, Oyetunji TA, Williams RF, Jancelewicz T, Dasgupta R, Arthur LG, Kawaguchi AL, Guner YS, Gosain A, Gates RL, Sola JE, Kelley-Quon LI, St Peter SD, Goldin A. Management of long gap esophageal atresia: A systematic review and evidence-based guidelines from the APSA Outcomes and Evidence Based Practice Committee. J Pediatr Surg 2019; 54:675-687. [PMID: 30853248 DOI: 10.1016/j.jpedsurg.2018.12.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 11/17/2018] [Accepted: 12/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment of the neonate with long gap esophageal atresia (LGEA) is one of the most challenging scenarios facing pediatric surgeons today. Contributing to this challenge is the variability in case definition, multiple approaches to management, and heterogeneity of the reported outcomes. This necessitates a clear summary of existing evidence and delineation of treatment controversies. METHODS The American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee drafted four consensus-based questions regarding LGEA. These questions concerned the definition and determination of LGEA, the optimal method of surgical management, expected long-term outcomes, and novel therapeutic techniques. A comprehensive search strategy was crafted and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized to identify, review and report salient articles. RESULTS More than 3000 publications were reviewed, with 178 influencing final recommendations. In total, 18 recommendations are provided, primarily based on level 4-5 evidence. These recommendations provide detailed descriptions of the definition of LGEA, treatment techniques, outcomes and future directions of research. CONCLUSIONS Evidence supporting best practices for LGEA is currently low quality. This review provides best recommendations based on a critical evaluation of the available literature. Based on the lack of strong evidence, prospective and comparative research is clearly needed. TYPE OF STUDY Treatment study, prognosis study and study of diagnostic test. LEVEL OF EVIDENCE Level II-V.
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Affiliation(s)
- Robert Baird
- Department of Pediatric General and Thoracic Surgery, BC Children's Hospital, University of British Columbia, 4480 Oak, Vancouver V6H3V4, British Columbia.
| | - Dave R Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin
| | - Robert L Ricca
- Division of Pediatric Surgery, Naval Medical Center, Portsmouth, Virginia
| | - Karen A Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Cynthia D Downard
- Hiram C. Polk Jr, MD Department of Surgery, University of Louisville, Louisville, KY
| | - Julia Shelton
- University of Iowa Stead Family Children's Hospital, Iowa City, IA
| | - Stig Sømme
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Aurora, CO
| | - Julia Grabowski
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tolulope A Oyetunji
- Department of Surgery, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Regan F Williams
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, Memphis, TN
| | - Tim Jancelewicz
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, Memphis, TN
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - L Grier Arthur
- Division of General, Thoracic, and Minimally Invasive Surgery, St. Christopher's Hospital for Children, Drexel University, Philadelphia, PA
| | - Akemi L Kawaguchi
- Department of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, TX
| | - Yigit S Guner
- Department of Surgery University of California Irvine and Division of Pediatric Surgery Children's Hospital of Orange County
| | - Ankush Gosain
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN
| | - Robert L Gates
- Clinical University of South Carolina-Greenville, Division of Pediatric Surgery, Greenville, SC
| | - Juan E Sola
- Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Shawn D St Peter
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108
| | - Adam Goldin
- Department of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA
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Fallon S, Barry W, Jackson J, Edmonds J, Kim E. Cautery ablation of a remote recurrent tracheoesophageal fistula. Journal of Pediatric Surgery Case Reports 2018; 31:1-3. [DOI: 10.1016/j.epsc.2017.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Piro E, Schierz IAM, Giuffrè M, Cuffaro G, La Placa S, Antona V, Matina F, Puccio G, Cimador M, Corsello G. Etiological heterogeneity and clinical variability in newborns with esophageal atresia. Ital J Pediatr 2018; 44:19. [PMID: 29373986 PMCID: PMC5787270 DOI: 10.1186/s13052-018-0445-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/02/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The aim of this study was to define different characteristics of infants with esophageal atresia and correlations with neonatal level of care, morbidity and mortality occurring during hospital stay. METHODS Charts of all newborns with esophageal atresia (EA) admitted to our University NICU between January 2003 and November 2016 were reviewed and subdivided in four groups related to different clinical presentations; EA as an isolated form (A), with a concomitant single malformation (B), as VACTERL association (C), and in the context of a syndrome or an entity of multiple congenital anomalies (D). RESULTS We recruited 67 infants with EA (with or without tracheoesophageal fistula), distributed in groups as follows: A 31.3%, B 16.4%, C 26.8% and D 25.3%. Type of atresia was not statistically different among different groups. Mortality was higher in groups C and D, especially if associated with congenital heart defects. In survivors, we found different auxological evolution and prognostic profiles considering duration in days of invasive mechanical ventilation and total parenteral nutrition, as well as length of stay and corrected gestational age at discharge. CONCLUSIONS In the context of genetic and syndromic entities, subjects with VACTERL association showed a lower mortality rate although a higher and more complex level of intensive care was noted in comparison to infants without VACTERL genetic and syndromic entities.
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MESH Headings
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/epidemiology
- Anal Canal/abnormalities
- Cohort Studies
- Databases, Factual
- Esophageal Atresia/diagnosis
- Esophageal Atresia/epidemiology
- Esophageal Atresia/genetics
- Esophagus/abnormalities
- Female
- Genetic Predisposition to Disease/epidemiology
- Gestational Age
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/genetics
- Hospital Mortality
- Humans
- Infant, Newborn
- Intensive Care Units, Neonatal
- Kidney/abnormalities
- Length of Stay
- Limb Deformities, Congenital/diagnosis
- Limb Deformities, Congenital/epidemiology
- Limb Deformities, Congenital/genetics
- Male
- Prognosis
- Retrospective Studies
- Risk Assessment
- Spine/abnormalities
- Survival Analysis
- Trachea/abnormalities
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Affiliation(s)
- Ettore Piro
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Ingrid Anne Mandy Schierz
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Mario Giuffrè
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Giovanni Cuffaro
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Simona La Placa
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Vincenzo Antona
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Federico Matina
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Giuseppe Puccio
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Marcello Cimador
- Pediatric Surgical Unit. A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Giovanni Corsello
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
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13
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Fayoux P, Morisse M, Sfeir R, Michaud L, Daniel S. Laryngotracheal anomalies associated with esophageal atresia: importance of early diagnosis. Eur Arch Otorhinolaryngol 2018; 275:477-81. [DOI: 10.1007/s00405-017-4856-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
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14
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Abstract
Recurrent tracheoesophageal fistula (rTEF) is a complex complication after the repair of esophageal atresia (EA) and remains a challenge because of difficulties in preoperative management and the substantial rates of mortality and morbidity after reoperation. By reviewing a single institution's experience in the management of rTEF and assessing the outcome, we aimed to provide an optimal approach for managing rTEF and to evaluate growth and feeding problems after reoperations. The medical records of 35 patients with rTEF treated at a single institution from June 2012 to December 2015 were reviewed, and follow-up data were collected from all survivors. The diagnosis of rTEF was made using a modified esophagram in 32 of 35 patients. Before reoperation, all patients received continuous aspiration to prevent reflux and aspiration pneumonia by placing two nasogastric tubes at the level of the fistula and into the stomach, and they received enteral nutrition through a jejunal feeding tube. Thirty-five patients received a total of 41 reoperations, including 12 operations of fistula resection, 28 reanastomosis, and 1 esophageal replacement. The incidence of postoperative anastomotic leak (AL), anastomotic stricture (AS), and repeat recurrences was 40.0%, 17.1%, and 11.4%, respectively. The mortality rate was 8.6%. All survivors achieved full oral intake. Mid-term follow-up (median of 18 months) revealed that 7 (21.9%) presented prolonged meal time, 6 (18.8%) had feeding refusal, 8 (25.0%) experienced coughing during feeding, and 7 (21.9%) had vomiting during feeding. According to the growth data, 5 survivors (15.6%) presented with growth retardation, including stunting (n = 1), wasting (n = 2), and underweight (n = 2). The modified esophagram is an effective and reliable method for diagnosing rTEF. Optimized preoperative management and surgical techniques lead to a satisfactory outcome. Nevertheless, nutritional evaluation and feeding guidance by a nutritionist after reoperation are recommended.
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Affiliation(s)
- J Wang
- Department of Pediatric Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine
| | - M Zhang
- Department of Pediatric Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine
| | - W Pan
- Department of Pediatric Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine
| | - W Wu
- Department of Pediatric Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine
| | - W Yan
- Department of Pediatric Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine
| | - W Cai
- Department of Pediatric Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine.,Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
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15
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Adam AB, Özdamar MY, Esen HH, Günel E. Local effects of epidermal growth factor on the wound healing in esophageal anastomosis: An experimental study. Int J Pediatr Otorhinolaryngol 2017; 99:8-12. [PMID: 28688571 DOI: 10.1016/j.ijporl.2017.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/02/2017] [Accepted: 05/22/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In this study with the experimental model of primary repair of esophageal atresia(EA), we investigated the effects of the epidermal growth factor(EGF) on wound healing in the anastomosis of EA. MATERIALS AND METHODS Forty rabbits that were performed a resection of a 1-cm segment of the cervical esophagus followed by the end-to-end anastomosis were divided into four groups. Group I (7-day group) and III (21-day group), the control groups, had no EGF applied to the anastomosis. In group II (7-day group) and group III (21-day group), all around the anastomoses were locally covered with 100 μg/kg EGF. Group 1, 2 and 3, 4 were sacrificed on the 7th and 21st day, respectively. We investigated and compared with bursting pressure, vascularization around the anastomotic line by histopathology, inflammation, and fibroblast granulation as well as hydroxyproline level by biochemical. RESULTS No significant difference was found at vascularization and inflammation between all of the groups (p > 0.05). Considering the critical parameters of the groups, at bursting pressure difference was found between group 1 and 2 as well as 3 and (p < 0.05). At fibroblast granulation and hydroxyproline level, no difference was found between group 1 and 2 (p > 0.05) but the difference between group 3 and 4 (p < 0.05). CONCLUSION EGF might be useful in preventing anastomotic leakage of esophageal atresia in primary anastomosis of esophageal atresia by accelerating wound healing process and increasing the stability of the anastomotic line.
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16
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Gregory S, Chun RH, Parakininkas D, Amos L, Fons R, Lerner DG, Lal DR, Sulman C. Endoscopic esophageal and tracheal cauterization for closure of recurrent tracheoesophageal fistula: A case report and review of the literature. Int J Pediatr Otorhinolaryngol 2017; 98:158-161. [PMID: 28583493 DOI: 10.1016/j.ijporl.2017.04.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/27/2017] [Accepted: 04/30/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Recurrent tracheoesophageal fistula (TEF) can be a diagnostic and therapeutic challenge. Traditional treatment is thoracotomy, which carries significant morbidity and technical difficulty especially in a previously operated field. Recently, endoscopic techniques have been advocated as a primary approach for treatment of recurrent TEF prior to open repair. This case report describes the endoscopic technique used to address a recurrent TEF. The existing literature of all reported endoscopic cauterization methods is reviewed. METHODS An 8 month old with proximal esophageal atresia and distal TEF underwent endoscopic closure of a recurrent TEF. The fistula was approached endotracheally utilizing Bugbee electrocautery (EC) and endoluminally through the esophagus using argon plasma coagulator and placement of porcine submucosa graft into the tract. Current literature review is presented with a synthesis of data on cases utilizing endoscopically applied EC and the combined results of this closure technique. RESULTS Our patient has maintained successful closure after a single treatment confirmed on follow up endoscopy 6 months post repair. Including this patient, there have been 30 patients with recurrent TEF treated utilizing endoscopic EC reported in the literature. The overall success rate is 78.8% with a mean of 1.88 procedures per successful closure. Comparing EC alone to EC combined with tissue glues or laser, success rates are 67% and 86% respectively. CONCLUSION Endoscopic repair of recurrent TEF has proven to be safe and effective in the literature as an alternative to a second thoracotomy/open surgical repair. EC combined with tissue glues or laser is more effective than EC alone based on available data.
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Affiliation(s)
- Stacie Gregory
- Department of Otolaryngology, Medical College of Wisconsin (MCW), Milwaukee, WI, United States.
| | - Robert H Chun
- Department of Otolaryngology, Medical College of Wisconsin (MCW), Milwaukee, WI, United States.
| | - Daiva Parakininkas
- Department of Pediatrics, Division of Pulmonary Medicine, MCW, Milwaukee, WI, United States.
| | - Louella Amos
- Department of Pediatrics, Division of Pulmonary Medicine, MCW, Milwaukee, WI, United States.
| | - Roger Fons
- Department of Anesthesiology, MCW, Milwaukee, WI, United States.
| | - Diana G Lerner
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, MCW, Milwaukee, WI, United States.
| | - Dave R Lal
- Department of Surgery, Division of Pediatric Surgery, MCW, Milwaukee, WI, United States.
| | - Cecille Sulman
- Department of Otolaryngology, Medical College of Wisconsin (MCW), Milwaukee, WI, United States.
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17
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Wallace B, Landman MP, Prager J, Friedlander J, Kulungowski AM. Button battery ingestion complications. Journal of Pediatric Surgery Case Reports 2017. [DOI: 10.1016/j.epsc.2016.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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18
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Zani A, Jamal L, Cobellis G, Wolinska JM, Fung S, Propst EJ, Chiu PP, Pierro A. Long-term outcomes following H-type tracheoesophageal fistula repair in infants. Pediatr Surg Int 2017; 33:187-90. [PMID: 27896423 DOI: 10.1007/s00383-016-4012-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate outcomes following repair of H-type tracheoesophageal fistula (TEF). METHODS Retrospective chart review of infants with H-type TEF treated at our institution between 2000 and 2014. Patient demographics, surgical management, and postoperative function were evaluated. RESULTS Of the 268 patients with esophageal atresia/TEF treated at our center, 16 (6%) had an H-type TEF (10 males). Thirteen (81%) had associated anomalies. All patients were symptomatic: choking and sputtering were the most common presentation (n = 10, 63%). Diagnosis Age at diagnosis was 8 days (1 day-34 months). All patients were diagnosed based on a single esophagogram. Prior to surgery, 12 (75%) patients underwent bronchoscopy and 11 underwent cannulation of the TEF tract. Surgery All patients underwent open repair. One was started thoracoscopically but converted to open due to esophageal sero-muscular injury. Repair was achieved in all patients via a transcervical approach (right-sided incision in 15). One patient had an unsuccessful prior attempt at repair using tissue glue. Following TEF division, 11 patients had tissue interposition grafts placed (9 muscle, 2 fat). Postoperative course Eight (50%) patients had postoperative vocal cord paresis (6 right-sided, 2 bilateral). A patient developed recurrent TEF 78 days postoperatively that was subsequently repaired. Follow-up At 41 months (8-143), there were no mortalities, all patients with vocal cord paresis were asymptomatic despite the fact that only 3 of 8 (38%) regained function, and nine (56%) patients had gastro-esophageal reflux requiring treatment. CONCLUSIONS This large, single-center series demonstrates that H-type TEF can be diagnosed with esophagogram at an early age. Postoperative recurrent laryngeal nerve paresis and gastro-esophageal reflux disease are common following repair. Although most patients with vocal cord paresis eventually become asymptomatic, two-thirds do not regain vocal cord function. This reinforces the importance of routine examination of vocal cord movement following H-type TEF repair.
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20
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Bhatia N, Kumari K, Soni S. Tracheoesophageal fistula repair in a neonate with tetralogy of Fallot: An anesthetic challenge. J Anaesthesiol Clin Pharmacol 2016; 32:411-2. [PMID: 27625509 PMCID: PMC5009867 DOI: 10.4103/0970-9185.188822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Nidhi Bhatia
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Kamlesh Kumari
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Shiv Soni
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
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21
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Okata Y, Maeda K, Bitoh Y, Mishima Y, Tamaki A, Morita K, Endo K, Hisamatsu C, Fukuzawa H, Yokoi A. Evaluation of the intraoperative risk factors for esophageal anastomotic complications after primary repair of esophageal atresia with tracheoesophageal fistula. Pediatr Surg Int 2016; 32:869-73. [PMID: 27461430 DOI: 10.1007/s00383-016-3931-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2016] [Indexed: 01/19/2023]
Abstract
PURPOSE The aim of this study is to identify the risk factors for esophageal anastomotic stricture (EAS) and/or anastomotic leakage (EAL) after primary repair of esophageal atresia with tracheoesophageal fistula (EA/TEF) in infants. METHODS A retrospective chart review of 52 patients with congenital EA/TEF between January 2000 and December 2015 was conducted. Univariate and multivariate analyses were performed to identify the risk factors for anastomotic complications. RESULTS Twenty-four patients were excluded from the analysis because they had insufficient data, trisomy 18 syndrome, delayed anastomosis, or multi-staged operations; the remaining 28 were included. Twelve patients (42.9 %) had anastomotic complications. EAS occurred in 12 patients (42.9 %), and one of them had EAL (3.57 %). There was no correlation between anastomotic complications and birth weight, gestational weeks, sex, the presence of an associated anomaly, age at the time of repair, gap between the upper pouch and lower pouch of the esophagus, number of sutures, blood loss, and gastroesophageal reflux. Anastomosis under tension and tracheomalacia were identified as risk factors for anastomotic complications (odds ratio 15, 95 % confidence interval (CI) 1.53-390.0 and odds ratio 8, 95 % CI 1.33-71.2, respectively). CONCLUSION Surgeons should carefully perform anastomosis under less tension to prevent anastomotic complications in the primary repair of EA/TEF.
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22
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Vukadin M, Savic D, Malikovic A, Jovanovic D, Milickovic M, Bosnic S, Vlahovic A. Analysis of Prognostic Factors and Mortality in Children with Esophageal Atresia. Indian J Pediatr 2015; 82:586-90. [PMID: 25724502 DOI: 10.1007/s12098-015-1730-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 02/12/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The survival rate in newborns with congenital esophageal atresia (EA) is about 85-90 %, and it raises over 95 % in the developed countries. The survival rate in developing countries is much lower and the authors describe their experience with 60 newborns. METHODS Medical records of 60 newborns (40 boys and 20 girls) with congenital EA were reviewed for the prognostic factors and mortality. RESULTS The birth weight, mean Apgar score (AS) value, gestational age and birth-operative treatment time had significant influence on the mortality of treated patients (p < 0.05). Thirty five percent newborns had aspirational pneumonia at the moment of hospitalization and 86.7 % of them were operated during the first 48 h. The presence of associated anomalies considerably affected the death rate of treated patients (p < 0.05). The incidence of postoperative complications was similar to those in developed countries but the total mortality was higher (28.3 %); sepsis being the main cause of mortality. The postoperative complications and sepsis significantly influenced the mortality of patients (p < 0.05). CONCLUSIONS Total mortality in newborns with EA was high; sepsis being the most frequent cause of death. The high total mortality was also caused by prematurity, delay in diagnosis, increased incidence of the aspiration pneumonia and shortage of qualified nurses.
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Affiliation(s)
- Miroslav Vukadin
- Institute for Mother and Child Health Care of Republic Serbia "Dr Vukan Cupic", Radoja Dakica 8 street, 11000, Belgrade, Serbia
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Berthet S, Tenisch E, Miron MC, Alami N, Timmons J, Aspirot A, Faure C. Vascular Anomalies Associated with Esophageal Atresia and Tracheoesophageal Fistula. J Pediatr 2015; 166:1140-1144.e2. [PMID: 25720367 DOI: 10.1016/j.jpeds.2015.01.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 12/16/2014] [Accepted: 01/21/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To report the incidence of congenital vascular anomalies in a cohort of patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) while describing the clinical presentation, diagnosis, and consequences, and to evaluate the diagnostic value of esophagram in diagnosing an aberrant right subclavian artery (ARSA). METHODS All patients born with EA/TEF between 2005 and 2013 were studied. Preoperative echocardiography reports, surgical descriptions of primary esophageal repair, and esophagrams were reviewed retrospectively. RESULTS Of the 76 children born with EA/TEF included in this study, 14 (18%) had a vascular malformation. The incidence of a right aortic arch (RAA) was 6% (5 of 76), and that of an aberrant right subclavian artery (ARSA) was 12% (9 of 76). RAA was diagnosed in the neonatal period by echocardiography (4 of 5) or surgery (1 of 5), and ARSA was diagnosed by echocardiography (7 of 9) or later on the esophagram (2 of 9). Respiratory and/or digestive symptoms occurred in 9 of the 14 patients with vascular malformation. Both long-gap EA and severe cardiac malformations necessitating surgery were significantly associated with vascular anomalies (P<.05). The sensitivity of the esophagram for diagnosing ARSA was 66%, the specificity was 98%, the negative predictive value was 95%, and the positive predictive value was 85%. CONCLUSION ARSA and RAA have an incidence of 12% and 6% respectively, in patients with EA/TEF. A computed tomography angioscan is recommended to rule out such malformations when stenting of the esophagus is indicated, before esophageal replacement surgery, and when prolonged (>2 weeks) use of a nasogastric tube is considered.
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Affiliation(s)
- Stéphanie Berthet
- Division of Pediatric Gastroenterology Hepatology and Nutrition, Sainte-Justine University Health Centre, Montreal, Québec, Canada
| | - Estelle Tenisch
- Division of Pediatric Radiology, Sainte-Justine University Health Centre, Montreal, Québec, Canada
| | - Marie Claude Miron
- Division of Pediatric Radiology, Sainte-Justine University Health Centre, Montreal, Québec, Canada
| | - Nassiba Alami
- Division of Pediatric Cardiology, Sainte-Justine University Health Centre, Montreal, Québec, Canada
| | - Jennifer Timmons
- Division of Surgery, Sainte-Justine University Health Centre, Montreal, Québec, Canada
| | - Ann Aspirot
- Division of Surgery, Sainte-Justine University Health Centre, Montreal, Québec, Canada
| | - Christophe Faure
- Division of Pediatric Gastroenterology Hepatology and Nutrition, Sainte-Justine University Health Centre, Montreal, Québec, Canada.
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25
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Aminde LN, Ebenye VN, Arrey WT, Takah NF, Awungafac G. Oesophageal atresia with tracheo-oesophageal fistula in a preterm neonate in Limbe, Cameroon: case report & brief literature review. BMC Res Notes 2014; 7:692. [PMID: 25286746 PMCID: PMC4196086 DOI: 10.1186/1756-0500-7-692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 10/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oesophageal atresia is a congenital anomaly in which there is interruption of the oesophageal lumen resulting in an upper and lower segment. We present the case of a rare sub-type of Oesophageal atresia with proximal trachea-oesophageal fistula associated with Meconium Aspiration Syndrome. This is the first case reported in literature in the South West Region of Cameroon. CASE PRESENTATION A 2 day old preterm male baby who presented as an emergency with difficulty breathing, fever and refusal to feed. Initially managed as early onset neonatal sepsis from meconium aspiration syndrome in which a diagnosis of oesophageal atresia was finally made. CONCLUSION A high index of suspicion for Oesophageal atresia/trachea-oesophageal fistula should prevail when faced with a neonate with the triad: respiratory distress during feeds, regurgitation and persistent frothy salivation. The case discusses the diagnostic dilemma and management difficulties in a preterm neonate with the above association in a low income setting.
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Affiliation(s)
- Leopold N Aminde
- Department of Paediatrics, Regional Hospital Limbe, Limbe, Cameroon.
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26
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Sharma D, Murki S, Pratap T. Anastomotic leak after primary repair of tracheoesophageal fistula: a dreadful condition. BMJ Case Rep 2014; 2014:bcr-2014-203982. [PMID: 25012885 DOI: 10.1136/bcr-2014-203982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Deepak Sharma
- Department of Neonatology, Fernandez Hospital, Hyderabad, Andhra Pradesh, India
| | - Srinivas Murki
- Department of Neonatology, Fernandez Hospital, Hyderabad, Andhra Pradesh, India
| | - Tejo Pratap
- Department of Neonatology, Fernandez Hospital, Hyderabad, Andhra Pradesh, India
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27
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Provenzano MJ, Rutter MJ, von Allmen D, Manning PB, Paul Boesch R, Putnam PE, Black AP, de Alarcon A. Slide tracheoplasty for the treatment of tracheoesophogeal fistulas. J Pediatr Surg 2014; 49:910-4. [PMID: 24888833 DOI: 10.1016/j.jpedsurg.2014.01.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/27/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study is to determine the surgical outcome of slide tracheoplasty for the treatment of tracheoesophageal (TE) fistula in pediatric patients. METHODS After internal review board approval, the charts of pediatric patients (0-18years old) who had undergone slide tracheoplasty for tracheoesophageal fistula were retrospectively reviewed. Patient information and surgical outcomes were reviewed. RESULTS Nine patients underwent slide tracheoplasty for correction of TE fistula. In five patients the original TE fistula was congenital. Other causes included battery ingestion, tracheostomy tube complications, foreign body erosion, and an iatrogenic injury. The average age at repair was 48±64 months (range: 1-190). Seven patients had undergone previous TEF repair either open or endoscopically. There were no recurrences after repair. Two patients had sternal periosteum interposed between the esophagus and trachea. There were no TEF recurrences. A single patient had dehiscence of the tracheal anastomosis and underwent a second procedure. CONCLUSION Slide tracheoplasty is an effective method to treat complex TE fistulas. The procedure was not associated with any recurrences. This is the first description of a novel, effective, and safe method to treat TE fistulas.
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Affiliation(s)
- Matthew J Provenzano
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026
| | - Michael J Rutter
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026.
| | - Daniel von Allmen
- Division of General and Thoracic Surgery, Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026
| | - Peter B Manning
- The Heart Center: Cardiology Cardiothoracic Surgery, St. Louis Children's Hospital, One Children's Place, Suite 5S50, Saint Louis, MO 63110
| | - R Paul Boesch
- Pediatric and Adolescent Medicine, Mayo Clinic, 201W Center St, Rochester, MN 55902
| | - Philip E Putnam
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026
| | - Angela P Black
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026
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Abstract
Esophageal strictures remain the most frequent complication after esophageal atresia (EA) repair despite refinements in operative techniques. With an incidence of anastomotic stricture between 8% and 49%, EA is the most frequent cause of benign esophageal stricture in children. The mainstay of treatment for esophageal stricture is dilatation with a 58-96% success rate. In order to relieve dysphagia, between 1 and 15 dilatations will be required in each EA patient with an esophageal stricture. However dilatations may lead to complications including perforation (0.1-0.4% of all esophageal benign strictures) and sociopsychological morbidity. Fifty percent of EA strictures will improve in 6 months. However, 30% will persist and require repeat dilatations. The present article explores the variety of non-surgical alternative treatments for anastomotic strictures after EA repair, focusing on triamcinolone acetonide, mitomycin C and esophageal stents. We propose an algorithm for a more standardized therapeutic approach, with the hope that an international panel of experts could meet and establish a consensus.
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Affiliation(s)
- D Lévesque
- Gastroenterology and Pediatric General Surgery Divisions, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada H3H1P3.
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29
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Garcia AV, Thirumoorthi AS, Traina JM, Schlossberg P, Sheynzon V, Kandel JJ. Image-guided esophageal anastomosis in esophageal atresia. J Pediatr Surg 2012; 47:1959-61. [PMID: 23084217 DOI: 10.1016/j.jpedsurg.2012.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 05/09/2012] [Accepted: 05/11/2012] [Indexed: 11/27/2022]
Abstract
Infants with tracheoesophageal fistulas may present with complex cardiac disease that may obviate or disrupt a safe operative repair. Here we present a case of an infant who developed cardiac instability during esophageal atresia repair, precluding formal anastomosis after approximation of the distal and proximal esophageal segments. Postoperatively, anastomosis of the esophagus was achieved using an image-guided technique with subsequent dilation. This approach may provide an alternative approach for establishment of esophageal continuity in patients who are high-risk operative candidates.
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Affiliation(s)
- Alejandro V Garcia
- Division of Pediatric Surgery, Department of Surgery, Morgan Stanley Children's Hospital, CHN 204, New York, NY 10032, USA.
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30
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Catalano P, Di Pace MR, Caruso AM, Salerno S, Cimador M, De Grazia E. A simple technique of oblique anastomosis can prevent stricture formation in primary repair of esophageal atresia. J Pediatr Surg 2012; 47:1767-71. [PMID: 22974622 DOI: 10.1016/j.jpedsurg.2012.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Revised: 03/06/2012] [Accepted: 04/14/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anastomotic stricture is an important problem after esophageal atresia (EA) repair. This study evaluates a technique of oblique esophageal anastomosis without use of a flap in order to prevent stricture formation. METHODS Medical records of 16 patients (14 with EA type III and 2 with EA type IV Ladd-Gross classification) who underwent primary repair of EA at birth without anastomotic tension were reviewed, evaluating long-term follow-up results. All patients were studied with esophageal contrast study, pH-multichannel intraluminal impedance, and endoscopy. The incidence of complications and their management were analysed. RESULTS Contrast esophagogram and esophagoscopy always showed regular patency of the suture line. CONCLUSIONS Our technique of oblique anastomosis is simple, safe, and effective in preventing stricture formation even in the long-term follow-up.
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Affiliation(s)
- Pieralba Catalano
- Pediatric Surgical Unit, Department of Mother and Child Care, University of Palermo, Palermo, Italy.
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31
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Friedmacher F, Puri P. Delayed primary anastomosis for management of long-gap esophageal atresia: a meta-analysis of complications and long-term outcome. Pediatr Surg Int 2012; 28:899-906. [PMID: 22875461 DOI: 10.1007/s00383-012-3142-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Management of newborns with long-gap esophageal atresia (LGEA) remains a challenge for pediatric surgeons. Since spontaneous growth of the esophageal segments occurs without mechanical stretching, initial gastrostomy followed by delayed primary anastomosis (DPA) comprises treatment in most LGEA patients. This meta-analysis aimed to investigate the complications and long-term outcome in patients with LGEA managed by DPA. METHODS A systematic literature search was conducted for relevant articles published between 1981 and 2011, and a meta-analysis of complications and long-term outcome was performed. RESULTS Forty-four articles presented data on 451 newborns with LGEA managed by DPA. Most common variants were pure LGEA (194/451) and LGEA with tracheoesophageal fistula (257/451). Initial gap lengths ranged from 1.9 to 7.0 cm. At the time of DPA, performed at a mean of 11.9 weeks (range 0.5-54.0), the gap had decreased to 0.5-3.0 cm. Mean follow-up was 5.5 years (range 0.5-27.0). Frequent complications were anastomotic leaks/strictures, gastroesophageal reflux (GER), esophagitis and dysphagia. Relative risk for strictures was significantly higher in patients who previously had a leak (p < 0.0001) or GER (p < 0.0001). Patients with GER also had a significantly higher risk for esophagitis (p = 0.0283) and dysphagia (p = 0.0174). The majority of patients could eat without swallowing difficulties at follow-up. CONCLUSION DPA provides good long-term functional results. However, the high incidence of GER and associated strictures requires early intervention to prevent feeding problems.
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Chang EY, Chang HK, Han SJ, Choi SH, Hwang EH, Oh JT. Clinical characteristics and treatment of esophageal atresia: a single institutional experience. J Korean Surg Soc 2012; 83:43-9. [PMID: 22792533 PMCID: PMC3392315 DOI: 10.4174/jkss.2012.83.1.43] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 05/11/2012] [Accepted: 05/26/2012] [Indexed: 01/12/2023]
Abstract
Purpose Treatment for esophageal atresia has advanced over several decades due to improvements in surgical techniques and neonatal intensive care. Subsequent to increased survival, postoperative morbidity has become an important issue in this disease. The aim of our study was to analyze our experience regarding the treatment of esophageal atresia. Methods We reviewed and analyzed the clinical data of patients who underwent surgery for esophageal atresia at Severance Children's Hospital from 1995 to 2010 regarding demographics, surgical procedures, and postoperative outcomes. Results Seventy-two patients had surgery for esophageal atresia. The most common gross type was C (81.9%), followed by type A (15.3%). Primary repair was performed in 52 patients. Staged operation was performed in 17 patients. Postoperative esophageal strictures developed in 43.1% of patients. Anastomotic leakages occurred in 23.6% of patients, and recurrence of tracheoesophageal fistula was reported in 8.3% of patients. Esophageal stricture was significantly associated with long-gap (≥3 cm or three vertebral bodies) atresia (P = 0.042). The overall mortality rate was 15.3%. The mortality in patients weighing less than 2.5 kg was higher than in patients weighing at least 2.5 kg (P = 0.001). During the later period of this study, anastomotic leakage and mortality both significantly decreased compared to the earlier study period (P = 0.009 and 0.023, respectively). Conclusion The survival of patients with esophageal atresia has improved over the years and the rate of anastomotic leakage has been significantly reduced. However, overall morbidities related to surgical treatment of esophageal atresia still exists with high incidence.
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Affiliation(s)
- Eun Young Chang
- Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
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33
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Abstract
This article focuses on selected topics in the diagnosis and management of patients with esophageal atresia (EA) with or without tracheoesophageal fistula. The current status of prenatal diagnosis and recent advances in surgical techniques, including thoracoscopic repair for short-gap EA and tension-induced esophageal growth for long-gap EA, are reviewed. Although no consensus exists among pediatric surgeons regarding the role of these procedures in the treatment of EA, one can reasonably expect that, as they evolve, their application will become more widespread in this challenging patient population.
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Affiliation(s)
- Shaun M Kunisaki
- Department of Surgery, Fetal Diagnosis and Treatment Center, C.S. Mott Children's and Von Voigtlander Women's Hospital, University of Michigan Medical School, 1540 East Hospital Drive, SPC 4211, Ann Arbor, MI 48109, USA.
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34
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Peyvasteh M, Askarpour S, Sarmast MH, Javaherizadeh H, Mehrabi V, Ahmadi J, Kalantari M. Esophageal atresia: comparison between survivors and mortality cases who underwent surgery over a 2-year period in two referral hospitals, Tehran, Iran. Annals of Pediatric Surgery 2012; 8:42-4. [DOI: 10.1097/01.xps.0000412346.91254.0e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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35
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Melek M, Cobanoglu U. A new technique in primary repair of congenital esophageal atresia preventing anastomotic stricture formation and describing the opening condition of blind pouch: plus ("+") incision. Gastroenterol Res Pract. 2011;2011:527323. [PMID: 21687616 DOI: 10.1155/2011/527323] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 02/26/2011] [Indexed: 11/17/2022] Open
Abstract
Anastomotic strictures are common and important problems following repair procedures of esophageal atresia. We hereby defined an anastomosis technique that could efficiently prevent this complication in 11 patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF). The proximal end of the atretic esophagus was opened with a plus (“+”)-shaped incision providing sufficient anastomosis width. Longitudinal incisions of 2 mm length were made on the anterior and posterior parts of the distal end according to the patients. The two ends were anastomosed with a primary suture at a single plain. We performed this technique on 11 patients, and in the 4-year follow-up period no dilatation proved necessary in any of our patients due to anastomotic strictures or symptomatic dysphagia. This technique that we have described provides a large zigzag anastomosis line and in this way minimizes the incidence of stricture formation. Furthermore, this technique, which we believe to have provided a new opinion on the topic of how to open the proximal end of an atretic esophagus, is quite easy and effective.
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36
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Hamrick SEG, Strickland MJ, Shapira SK, Autry A, Schendel D. Use of special education services among children with and without congenital gastrointestinal anomalies. Am J Intellect Dev Disabil 2010; 115:421-432. [PMID: 20687825 DOI: 10.1352/1944-7558-115-5.421] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Our objective was to evaluate the relationship between congenital gastrointestinal anomalies requiring neonatal surgery and neurodevelopmental outcome. Among the children born in metropolitan Atlanta during 1982-2001 who survived to age 1 year (N = 762,824), we identified children with congenital gastrointestinal anomalies via linkage with the Metropolitan Atlanta Congenital Defects Program and children who received special education services via linkage with the Special Education Database of Metropolitan Atlanta. Several modest increases in special education service use were observed among children with isolated congenital gastrointestinal anomalies; no association was statistically significant. Among children with Hirschsprung disease, gastroschisis, esophageal atresia, intestinal malrotation, bowel atresia, or imperforate anus who had multiple anomalies, we observed statistically significant increases in special education service use.
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Affiliation(s)
- Shannon E G Hamrick
- Emory University School of Medicine, Division of Neonatology, Atlanta, GA 30322, USA.
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37
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Yoo HJ, Kim WS, Cheon JE, Yoo SY, Park KW, Jung SE, Shin SM, Kim IO, Yeon KM. Congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula: clinical and radiologic features. Pediatr Radiol 2010; 40:1353-9. [PMID: 20221592 DOI: 10.1007/s00247-010-1603-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 01/24/2010] [Accepted: 02/09/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Congenital esophageal stenosis (CES) can be associated with esophageal atresia/tracheoesophageal fistula (EA/TEF). Because there are a variety of degrees of obstruction and symptoms of CES, it is frequently difficult to make a pre- and post-operative diagnosis of the distal CES associated with EA/TEF. OBJECTIVE To evaluate the clinical and radiologic features of congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula. MATERIALS AND METHODS We retrospectively reviewed postoperative esophagograms and medical records of 187 children (107 boys, 80 girls) who had primary repair of EA/TEF from 1992 to 2009 at our institution. We evaluated the incidence of CES, clinical findings, radiologic features and management of CES in these children. RESULTS CES was diagnosed in 22 of 187 EA/TEF children (12%); one child had double CES lesions, for a total of 23 lesions. Ten of those 22 children (45%) had presented with significant symptoms of esophageal obstruction. The diagnosis of CES was delayed in 10 children (45%) until 1-10 years of age. On esophagogram, CES (n = 23) was located in the distal esophagus (n = 20, 87%) or mid-esophagus (n = 3, 13%). The degree of stenosis was severe (n = 6, 26%), moderate (n = 10, 43%), or mild (n = 7, 30%). Eight children, including two with unsuccessful esophageal balloon dilatation of CES, were treated surgically. Histologic examination revealed tracheobronchial remnant (n = 7) or fibromuscular hyperplasia (n = 1). One child with surgically treated CES developed achalasia at the age of 3 years 9 months. CONCLUSION Esophagography after EA/TEF repair should be performed with a high index of suspicion for the presence of distal CES, because the diagnosis and adequate management of CES can often be delayed.
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Serhal L, Gottrand F, Sfeir R, Guimber D, Devos P, Bonnevalle M, Storme L, Turck D, Michaud L. Anastomotic stricture after surgical repair of esophageal atresia: frequency, risk factors, and efficacy of esophageal bougie dilatations. J Pediatr Surg 2010; 45:1459-62. [PMID: 20638524 DOI: 10.1016/j.jpedsurg.2009.11.002] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 10/20/2009] [Accepted: 11/09/2009] [Indexed: 12/11/2022]
Abstract
AIMS The aim of this study was to evaluate the frequency and risk factors of postoperative anastomotic stricture, and the efficacy and complications of esophageal bougie dilatations for symptomatic anastomotic stricture in a population of children with esophageal atresia. PATIENTS AND METHODS The medical records of 62 children operated on for esophageal atresia type III (Ladd and Gross) over a 5-year period were retrospectively reviewed. RESULTS Anastomotic stricture developed in 23 (37%) of patients. Anastomotic tension during primary repair of esophageal atresia was associated with subsequent stricture formation (P < .05). Patients required esophageal dilation at a mean age of 149 days (range, 30-600 days). Stricture resolution occurred after a mean of 3.2 dilatations per patient (range, 1-7). Dilation was successful in 87% of patients. Three patients continued to present mild (n = 1) to severe (n = 2) dysphagia, mainly related to esophageal dysmotility. No complications were observed during or after the dilatation sessions. CONCLUSIONS Anastomotic stricture, secondary to the surgical treatment of esophageal atresia, remains a frequent complication in patients with esophageal atresia. Esophageal dilation with Savary-Gilliard bougies is a safe and effective procedure in the management of strictures.
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Affiliation(s)
- Lydia Serhal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Jeanne de Flandre Children's University Hospital and Lille University Faculty of Medicine, Lille, France
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Castilloux J, Noble AJ, Faure C. Risk factors for short- and long-term morbidity in children with esophageal atresia. J Pediatr 2010; 156:755-60. [PMID: 20123142 DOI: 10.1016/j.jpeds.2009.11.038] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 09/04/2009] [Accepted: 11/11/2009] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe short- (first year of age) and long-term (after 1 year of age) outcome in patients with esophageal atresia and identify early predictive factors of morbidity in the first month of life. STUDY DESIGN Charts of children with esophageal atresia born January 1990 to May 2005 were reviewed. A complicated evolution was defined as the occurrence of at least 1 complication: severe gastroesophageal reflux, esophageal stricture requiring dilatations, recurrent fistula needing surgery, need for gavage feeding for >or=3 months, severe tracheomalacia, chronic respiratory disease, and death. RESULTS A total of 134 patients were included. Forty-nine percent of patients had a complicated evolution before 1 year of age, and 54% had a complicated evolution after 1 year. With bivariate analysis, predictive variables of a complicated evolution were demonstrated, including twin birth, preoperative tracheal intubation, birth weight <2500 g, long gap atresia, anastomotic leak, postoperative tracheal intubation >or=5 days, and inability to be fed orally by the end of the first month. After 1 year of age, the complicated evolution was only associated with long gap atresia and inability to be fed orally in the first month. A hospital stay >or=30 days was associated with a risk of a complicated evolution at 1 year and after 1 year of age (odds ratio, 9.3 [95% CI, 4.1-20.8] and 3.5 [95% CI, 1.6-7.6], respectively). CONCLUSION Early factors are predictive of morbidity in children with esophageal atresia.
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40
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Chung J, Connolly B, Langer J, Marcon M, Temple M, Amaral JG. Fluoroscopy-guided Topical Application of Mitomycin-C in a Case of Refractory Esophageal Stricture. J Vasc Interv Radiol 2010; 21:152-5. [DOI: 10.1016/j.jvir.2009.09.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 08/31/2009] [Accepted: 09/27/2009] [Indexed: 01/18/2023] Open
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41
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Petrosyan M, Estrada J, Hunter C, Woo R, Stein J, Ford HR, Anselmo DM. Esophageal atresia/tracheoesophageal fistula in very low-birth-weight neonates: improved outcomes with staged repair. J Pediatr Surg 2009; 44:2278-81. [PMID: 20006009 DOI: 10.1016/j.jpedsurg.2009.07.047] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 07/31/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The surgical management of esophageal atresia with distal tracheoesophageal fistula (EA/TEF) involves early division of the TEF and primary esophageal anastomosis. However, in premature infants, the morbidity associated with primary repair remains high, and the optimal surgical approach has not been well defined. METHODS Medical records of very low-birth-weight infants (<1500 g) with EA/TEF from June 1987 to 2008 were retrospectively reviewed. Patients were separated into 2 groups: (1) primary repair and (2) ligation and division of TEF followed by delayed repair of EA. Demographics, anastomotic, and postoperative complications were compared. RESULTS Twenty-five premature infants with EA/TEF were identified. Sixteen patients (64%) underwent primary repair, and 9 (36%) were repaired in a staged manner. The leak rate confirmed by esophagram was significantly higher after primary repair (50%) compared to staged repair (0%) (P = .034). Strictures occurred significantly more often in the primary repair (81%) vs the staged repair (33%) group (P = .036). Postoperative pneumonia and sepsis were significantly higher in patients treated with primary repair (P = .028). CONCLUSION Staged repair of EA/TEF in very low-birth-weight premature infants results in a significantly lower rate of anastomotic complications and overall morbidity and should be considered the preferred surgical approach in this group of patients.
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Affiliation(s)
- Mikael Petrosyan
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
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42
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Schulte T, Ankermann T, Claas A, Engler S. An extremely rare abnormality of a double tracheoesophageal fistula without atresia of the esophagus; a case report and review of the literature. J Pediatr Surg 2009; 44:e9-12. [PMID: 19853739 DOI: 10.1016/j.jpedsurg.2009.06.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Revised: 05/28/2009] [Accepted: 06/23/2009] [Indexed: 10/20/2022]
Abstract
Tracheoesophageal fistulas without atresia of the esophagus are rare abnormalities of the upper gastrointestinal tract with an incidence rate of between 1% and 5%. Even more infrequent are 2 tracheoesophageal fistulas without atresia of the esophagus. This case report illustrates the history of an infant with 2 tracheoesophageal fistulas. The corresponding literature was reviewed, and a diagnostic algorithm was described.
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Affiliation(s)
- Tobias Schulte
- Division of Pediatric Surgery, Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
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43
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Gunlemez A, Anik Y, Elemen L, Tugay M, Gökalp AS. H-type tracheoesophageal fistula in an extremely low birth weight premature neonate: appearance on magnetic resonance imaging. J Perinatol 2009; 29:393-5. [PMID: 19399000 DOI: 10.1038/jp.2008.198] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Many diagnostic methods have been used to establish the diagnosis for a suspected H-type tracheoesophageal fistula (TEF). In case of a strong assumption of an H-type fistula, besides all standard diagnostic work-up tools a more aggressive combined approach is advisable. However, in a critically ill premature infant, conventional invasive investigations could not be performed as being potentially hazardous and not always easy to achieve. We describe the unique imaging features of an H-type TEF on magnetic resonance imaging (MRI). Our case demonstrates that MR images could be used for diagnosis, and localization of an H-type TEF could be detected safely and accurately in a sick preterm infant.
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Affiliation(s)
- A Gunlemez
- Department of Pediatrics, Section of Neonatology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
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44
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Coopman S, Michaud L, Halna-Tamine M, Bonnevalle M, Bourgois B, Turck D, Gottrand F. Long-term outcome of colon interposition after esophagectomy in children. J Pediatr Gastroenterol Nutr 2008; 47:458-62. [PMID: 18852638 DOI: 10.1097/MPG.0b013e31815ce55c] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Tissues derived from the colon, stomach, and jejunum have been used to replace the esophagus in childhood to cure esophageal atresia or stricture secondary to gastroesophageal reflux or the ingestion of corrosive agents. The outcome in adulthood of colon interposition performed at an early age has yet to be satisfactorily assessed. The aim of this single-center retrospective study was to evaluate the long-term nutritional, digestive, and respiratory outcome of all patients (n = 32) who underwent colon interposition during childhood in our hospital (1970-2001). PATIENTS AND METHODS Medical records of these subjects were reviewed and their nutritional (weight, height, 24-hour food diary), digestive (questionnaire), and pulmonary function status evaluated. RESULTS Of the patients, 17 had esophageal atresia (7 males, median age at surgery 11 months, range 0.5-61) and 15 had ingested corrosive substances (10 males, median age at surgery 50 months, range 22-113). Complications occurred less than 1 year postoperatively in 53% and long-term complications (occurring >1 year after surgery) in 84%. Long-term complications were common: digestive symptoms were found in 85% (most frequently observed during the first 5 years of follow-up), abnormal lung function in 7 (58%) of those tested (n = 12), feeding difficulties in 50%, scoliosis in 35%, and nutritional complications in 25%. CONCLUSIONS Our study showed a high rate of sequelae following esophageal replacement. This highlights the need for multidisciplinary long-term follow-up into adulthood, and research into alternatives to colon interposition as treatment for esophageal strictures.
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Abstract
BACKGROUND The diagnosis of long gap esophageal atresia (LGEA) may preclude immediate primary anastomosis. We reviewed our experience with this entity for a period of 10 years. METHODS A retrospective review was undertaken of the medical records of all patients managed for esophageal atresia (EA)/tracheoesophageal fistula (TEF) during the period from 1991 to 2001 at the Children's Hospital at Westmead, Sydney, Australia. Esophageal atresia was defined as long gap when primary repair was considered technically impossible by the surgeon. Also, a questionnaire was sent to all the general pediatric surgeons in Australia to explore their attitude toward LGEA management. RESULTS One hundred three patients with EA were managed for that period, 17 (16%) of them were defined as LGEA, with mean gap of 5 cm (SD, 1cm). Eight patients (47%) had TEF. Sixteen patients had gastrostomy tube (GT) insertion at a mean age of 4 days. Six patients had esophagostomy at a mean age of 27 days. Thirteen patients had EA repair at a mean age of 146 days. Four patients died before repair and 2 after repair secondary to associated anomalies. Fifty percent of Australian Pediatric Surgeons (APS) responded to the questionnaire. Forty percent defined LGEA as a gap more than 3 to 4 vertebral bodies, whereas 24% considered the absence of TEF as an indication of LGEA. Fifty-six percent of APS will measure the gap on preoperative chest x-rays, and 80% will assess the gap at thoracotomy for ligation of TEF. Ninety-two will measure the gap by inserting a bougie into the upper pouch and into the lower esophagus via the GT. If LGEA was diagnosed, all APS will perform GT with delayed repair. Seventy-two percent of APS will attempt delayed primary repair within 3 to 6 months of age. Seventy-six percent will perform hiatal dissection, and 48% will use upper pouch myotomies. Forty-eight percent will perform gastric pull up, and 32% will use gastric tube for esophageal replacement. CONCLUSIONS Long gap esophageal atresia represents a surgical challenge. Mortality rate is high secondary to associated anomalies. There is no consensus among APS regarding the definition of LGEA. In general, the consensus of APS would be that the preservation of the patient's own esophagus should be attempted before considering the use of an esophageal replacement.
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Affiliation(s)
- Saud Al-Shanafey
- Department of Surgery, The Children's Hospital at Westmead, Sydney, Australia.
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Upadhyaya VD, Gopal SC, Gangopadhyaya AN, Gupta DK, Sharma S, Upadyaya A, Kumar V, Pandey A. Role of fibrin glue as a sealant to esophageal anastomosis in cases of congenital esophageal atresia with tracheoesophageal fistula. World J Surg 2008; 31:2412-5. [PMID: 17917772 DOI: 10.1007/s00268-007-9244-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was to characterize a successful approach for the management of infants with long-gap esophageal atresia (EA) with tracheoesophageal fistula (TEF). The goal was to preserve the native esophagus and minimize the incidence of esophageal anastomotic leaks using fibrin glue as a sealant over the esophageal anastomosis. METHOD A total of 52 patients were evaluated in this study. Only patients in whom, gap between the two ends of the esophagus was > or = 2 cm were selected during January 2005 to January 2007. Patients were divided in two groups on the basis of block randomization. Group A comprised the patients in whom fibrin sealant was used as reinforcement on a primary end-to-end esophageal anastomosis; in group B, fibrin glue was not used. The two groups were compared in terms of esophageal anastomotic leak (EL), postoperative esophageal stricture (ES), and mortality. The statistical analysis was done using Fisher's exact test and the chi-squared test. RESULT The number of anastomotic leaks in group A (glue group) was about one-fifth that in group B (no glue group). The incidence of ES was almost twice as high in group B as in group A. The mortality rate was almost threefold higher in group B (no-glue group). The higher incidence of EL and ES in group B compared to group A was statistically significant. CONCLUSION Thus, fibrin glue when used as an adjunct to esophageal anastomosis for primary repair of long-gap EA with TEF appears safe in the clinical setting and may lower the chances of esophageal leak and anastomosis-site strictures. Hence, it can diminish the mortality and morbidity of these patients.
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Affiliation(s)
- Vijai D Upadhyaya
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Lanka, Varanasi, UP, India.
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Richter GT, Ryckman F, Brown RL, Rutter MJ. Endoscopic management of recurrent tracheoesophageal fistula. J Pediatr Surg 2008; 43:238-45. [PMID: 18206490 DOI: 10.1016/j.jpedsurg.2007.08.062] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 08/28/2007] [Accepted: 08/28/2007] [Indexed: 10/22/2022]
Abstract
RATIONALE Recurrent tracheoesophageal fistulas (RTEFs) remain a therapeutic challenge because open surgical approaches have been associated with substantial rates of morbidity, mortality, and repeat recurrences. Recently, endoscopic techniques for the repair of RTEF have provided an alternative approach with the potential for improved surgical outcomes. However, previous reports have been limited by small patient numbers and variations in technique. By examining a single institution's experience and performing a systematic review of previously published results, we aimed to identify an optimal approach to managing RTEF endoscopically. METHODS Retrospective chart review of patients undergoing endoscopic management of RTEF at a single tertiary care institution was performed. Medline search and summated analysis of previously published cases of endoscopically treated RTEF from 1975 to 2007 was conducted. RESULTS Four patients with RTEF were identified and selected for endoscopic repair at our institution from 2003 to 2007 (mean age, 11.5 months). Under endoscopic guidance, fistula tracts were de-epithelialized with a Bugbee fulgurating diathermy electrode (5-15 W) and then sealed with fibrin glue (Tisseel with added aprotinin). Closure of RTEF was successful in 3 patients after a single attempt. One revision was required after inadvertent recannulation of the tract with an emergent tracheostomy tube change. No patient has evidence of recurrence (mean follow-up, 16 months). In 15 articles of endoscopically repaired RTEF, 37 cases have been reported from 1975 until present. In general, 3 approaches to endoscopic repair have been explored. Analysis of all reported cases in the literature and results from our patient series suggests that endoscopic techniques designed to both de-epithelialize the fistula tract and seal with fibrin glue have the best chance for cure after a single attempt. Patients with long, thin, and small diameter fistula who have enough distal trachea to accommodate a postoperative cuffed ventilating tube beyond the fistula are ideal candidates for endoscopic repair. CONCLUSION In select patients, endoscopic management of RTEF using Bugbee cautery and tissue adhesives can reduce morbidity and recurrence associated with open approaches and alternative endoscopic techniques.
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Affiliation(s)
- Gresham T Richter
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45208, USA
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St Peter SD, Calkins CM, Holcomb GW. The use of biosynthetic mesh to separate the anastomoses during the thoracoscopic repair of esophageal atresia and tracheoesophageal fistula. J Laparoendosc Adv Surg Tech A 2007; 17:380-2. [PMID: 17570793 DOI: 10.1089/lap.2006.0138] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recurrent tracheoesophageal fistula following the repair of esophageal atresia and tracheoesophageal fistula (EA/TEF) is a difficult complication to manage, which makes prevention the dominant concern of surgeons performing the primary repair. To this end, the surrounding pleural tissues are usually brought over the tracheal closure to prevent the development of a recurrence during the open repair. This maneuver is not usually feasible when using the thoracoscopic approach. Therefore, in this paper, we describe a case in which we interposed a biosynthetic mesh between the esophageal and tracheal suture lines during the thoracoscopic repair of EA/TEF on a 2.9-kg newborn girl.
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Affiliation(s)
- Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri 64108, USA
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Abstract
We present 2 cases of successful treatment of recurrent anastomotic strictures using a topical application of mitomycin C. In the first case, a 4-year-old boy had a cervical cyst excised, which appeared to be an ectopic gastric mucosa. He consequently presented severe stenosis at the origin of the cervical esophagus that needed repeated balloon dilatations. The second case is about a 12-year-old girl who presented a traumatic complete rupture of the right mainstem bronchus managed by primary repair, with subsequent anastomotic stricture. Both patients were successfully managed with topical application of mitomycin C (1 mg/mL), and needed no more dilatations.
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Affiliation(s)
- Paul Daher
- Department of Pediatric Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon.
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Upadhyaya VD, Gangopadhyaya AN, Gupta DK, Sharma SP, Kumar V, Pandey A, Upadhyaya AD. Prognosis of congenital tracheoesophageal fistula with esophageal atresia on the basis of gap length. Pediatr Surg Int 2007; 23:767-71. [PMID: 17579871 DOI: 10.1007/s00383-007-1964-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2007] [Indexed: 02/06/2023]
Abstract
Congenital tracheoesophageal fistula (TEF) with esophageal atresia (EA) is not an uncommon disease of newborns. Several classifications have been advocated for predicting the outcomes of these patients but all are physiological and concentrated on associated medical condition that influences survival. We emphasize a new classification on the basis of gap between two esophageal pouches to define the magnitude of surgical problems in the primary repair and correlate them with the outcomes in terms of anastomotic leak, esophageal stricture and mortality, keeping other prognostic factors constant. A total of 50 cases of congenital TEF with EA were included and all underwent primary esophageal anastomosis after the ligation of TEF. The gap between the two pouches was meticulously measured intraoperatively using a vernier caliper before the ligation of TEF, and patients were divided into four groups on the basis of gap length. Group A, where gap length was >3.5 cm (ultralong), group B where gap length was 2.1-3.5 cm (long gap), group C where gap length was >1 cm but not more than 2 cm (intermediate group) and group D, where the gap between two esophageal pouches was 1 cm or less (short gap). The incidence of anastomotic leak was 80, 50, 28, 10.5% and the incidence of esophageal stricture was 100, 75, 22.5, 19% after successful primary repair, respectively, in groups A, B, C and D. The mortality was highest in group A (80%) followed by group B (50%) and 22% in group C and least 15.6% in group D. The incidences of esophageal leak and mortality were found to be statistically significant. This classification which is based on easily measurable criteria provides a useful method to predict morbidity, long-term outcome and mortality of EA with TEF surgery.
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Affiliation(s)
- Vijay D Upadhyaya
- Department of Pediatric Surgery, IMS, BHU, Varanasi 221005, Uttar Pradesh, India
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