Abstract
Purpose: This study was performed to evaluate the management of tracheoesophageal fistula (TEF) ± esophageal atresia (EA) under the guidance of preoperative tracheo-bronchoscopy (TrSc). Methods: Between 2007 and July 2014, a total of 26 consecutive newborns who underwent rigid TrSc for suspected TEF were identified. All associated charts and operation reports were retrospectively analyzed. Results: Distal TEF with EA (Gross C) predominated (n = 18). Furthermore, we managed 2 infants with proximal and distal TEF (Gross D) and 4 infants with isolated TEF (Gross E). In our hands, TrSc was feasible in infants with a birth weight above 1300 g. Twenty-five fistulas were identified by endoscopy in 23 patients. In one infant with a birth weight below 1000 g, an attempt to perform TrSc was interrupted, and urgent TEF closure was required. Fistula site at the carina was associated with a high rate of esophageal anastomosis under tension. During surgery, proximal TEF and isolated TEF were safely approached via right cervicotomy (n =5). Conclusion: This study supports the routine use of rigid TrSc at the time of surgery. Rigid TrSc allowed the surgical team to identify the number and location of TEFs, and the incidence of side effects was low.
Highlights
The overall prevalence of esophageal atresia (EA) in Europe is 2.43 cases per 10,000 births; locally, the prevalence can be as high as 4.5 per 10,000 births (Mainz, Germany) [1]
Failure to pass a nasogastric tube into the stomach and the presence of air in the upper gastrointestinal tract on X-ray of the thorax and abdomen indicate the presence of distal tracheoesophageal fistula (TEF) with EA
Surgical repair always began with endoscopy of the airway, and surgery was immediately continued with dissection of the TEF and esophageal anastomosis, if required
Summary
The overall prevalence of esophageal atresia (EA) in Europe is 2.43 cases per 10,000 births; locally, the prevalence can be as high as 4.5 per 10,000 births (Mainz, Germany) [1]. In more than 4 of every 5 cases, EA is associated with at least one tracheoesophageal fistula (TEF). At surgery closure of TEF is the most important step to stabilize the infant and to prevent severe airway morbidity. Preoperative tracheo-bronchoscopy (TrSc) is routinely employed to determine the presence, site, and number of TEFs. according to a recent international survey on the management of esophageal atresia, the use of perioperative endoscopy remains controversial [3] [4]. The aim of the present study was to evaluate the primary management of TEF ± EA in a medium-sized center with 2200 operations per year. TrSc and surgical repair were routinely performed within the same operation. As a follow-up, we assessed surgically relevant airway morbidity over the first 3 months postoperatively
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