MODERN APPROACHES TO DIAGNOSIS AND SURGICAL TREATMENT OF ESOPHAGO-TRACHEAL COMMUNICATION IN CHILDREN

Abstract

Introduction. Congenitalesophago-tracheal communication in a variant of isolated trachea-esophageal fistula (ITEF) is uncommon malformation with frequency 1:100000, characterized by high rates of complications and mortality.Proper diagnosis and, hence, surgery is often delayed and the methods of operation are disputable.Aim of the Studywas to optimize the diagnosis and surgical correction of congenitalisolated trachea-esophageal fistula in children.Methods. We included the data of 39 patients with congenital ITEF. Diagnosis was confirmed by clinical symptoms, esophagography, tracheoscopy with fistula catheterization and esophagoscopy. Fistula dividing was the goal of surgery. Typical approach was cervicotomy (n=34). Application of auto-tissue strips, dislocation of tracheal and esophageal suture lines and tracheoplasty with demucosated wall of the fistula were used to prevent fistula recurrence.Efficacy was evaluated by comparing the results of tracheoplasty (group I) and other methods (group II).Results. Age ranged from 2 days to 16 years (mean 9.4±4.9 months). Most of them were newborns (n=11, 28.2%) and children under 6 months of age (n=31, 79,4%).Thirty six(92.4%) patients were operated on.Postoperative complications occurred in 9 (25%) cases: suture leak (n=6; 16.7%), fistula recurrence (n=3; 8.3%).Positive long-term outcome was reached in 33 of 36 operated patients(91.7%). Postoperative mortality was 8.3% (n=3).Three patients were admitted to our clinic in a terminal condition due to aspiration pneumonitis and sepsis and died before surgery could be carried out.The effectiveness of tracheoplasty with demucosatedwall of a fistulawas proved at comparison of frequency of uncomplicated course in group І (n=5, 100%) and ІІ (n=22, 70.9%), p=0.021.Conclusion.Congenital ITEF is subject to surgical correction from cervical approach. Tracheoplasty with demucosated fistula wall is an effective method of treatment of congenital isolated trachea-esophageal fistula and prevents complications.