Lower esophageal banding in extremely low birth weight infants with esophageal atresia and tracheoesophageal fistula is a life saving practice followed by a successful delayed primary thoracoscopy reconstruction

Abstract

In extremely low birth weight (ELBW) infants, i.e. <1000g, with esophageal atresia (EA) and tracheoesophageal fistula (TEF), surgical treatment is a real challenge. High morbidity is associated with primary repair of EA on these patients. We report our recent experience with three cases of ELBW infants with EA and TEF treated by lower esophageal banding (LEB).From September 2012 to January 2013, three ELBW infants with EA/TEF were born prematurely with severe respiratory distress. One of them had VACTER association with anorectal malformation (ARM). The gestational age was between 25 and 27weeks, and the mean birth weight was 690g (500–790). All were treated by LEB and gastrostomy, followed by delayed primary thoracoscopy reconstruction.One baby died in the postoperative period because of intraventricular hemorrhage at 7days after initial surgery. Among the 2 others cases, one of them required ligation without section of the TEF with removal of LEB by thoracoscopy at 30days old and 1300g. Delayed primary thoracoscopy reconstruction and section of TEF were performed by thoracoscopy at 70 and 80days old and 2100g and 2200g respectively without early complication.The follow-up was 12months. One baby presented a stenosis requiring one dilation of lower esophagus with uneventful course.LEB is a life saving practice in ELBW babies with EA and TEF. The esophagus can tolerate the ligation even with a thread without having a long time major complication. Thoracoscopic reconstruction of the esophagus is possible in these babies.