Cases Of Esophageal Atresia Research Articles

Detail correction for Gross classification of esophageal atresia based on 434 cases in China.

Detail correction for Gross classification of esophageal atresia based on 434 cases in China.

Prenatal ultrasonographic findings of esophageal atresia: potential diagnostic role of the stomach shape.

ObjectiveWe investigated prenatal sonographic characteristics of esophageal atresia (EA) with advancing gestation. We focused on the degree of polyhydramnios and the stomach shape.MethodsThis study included 27 EA cases (EA group) and 81 idiopathic polyhydramnios cases (non-EA group). The non-EA group consisted of cases without any fetal structural anomaly, musculoskeletal disorder, chromosomal abnormality, or maternal diabetes. Both groups included only singleton pregnancies. Amniotic fluid index (AFI) and width/length (W/L) ratio as well as the product of width and length (W×L) of stomach were serially assessed during gestation and compared between the 2 groups. To predict EA using W/L ratio and W×L, receiver operating characteristic curve analysis was performed.ResultsPolyhydramnios was evident in 77.8% of EA cases. We observed 25.9% and 22.2% EA cases with an absent stomach and a small visible stomach, respectively. After 28 weeks, the EA group manifested significantly higher AFI than the non-EA group. After 32 weeks, W/L ratio in the EA group tended to be lower than that in the non-EA group (32–36 weeks: 1.36 vs. 1.72, P=0.092; >36 weeks: 1.43 vs. 1.63, P=0.024). To predict EA, the calculated area under the curve for W/L ratio was 0.651 after 32 weeks. The diagnosis of EA using a cut-off value of W/L ratio <1.376 showed sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio to be 84.6%, 52.9%, 1.796, and 0.081, respectively.ConclusionA low W/L ratio of stomach after 32 weeks with progressive idiopathic polyhydramnios may be used to predict EA.

Diagnosis of Fetal Esophageal Atresia by Prenatal MRI and Analysis of Prognostic Factors

Objective To investigate the value of prenatal ultrasound and MRI in the diagnosis of types I and III fetal esophageal atresia (EA), in addition to analyzing the factors related to prognosis. Methods The clinical data regarding six cases of type I and 39 cases of type III EA, with the diagnosis confirmed by postnatal autopsy, MRI, CT, or surgical operation from November 2012 to January 2018, were retrospectively analyzed. Moreover, the prenatal ultrasound and MRI features were summarized. According to the prognosis, 45 fetuses with EA were divided into study (poor prognosis) and control (better prognosis) groups. Logistic regression was used to analyze the prognostic factors. Results The imaging features of 45 EA cases were as follows: Ultrasound features of fetal EA: polyhydramnios (AFI ≥ 25), continuously absent stomach bubble (rechecked 48 hours later), and reduced or no fetal swallowing over 30 minutes; the measured values for fetal head circumference (HC), abdominal circumference (AC), and estimated fetal weight (EFW) were lower than expected according to the clinical gestational age. MRI features: appearance of line-like long T1 and long T2 signals from the fetal neck to the esophagus at the upper mediastinal spinal anterior area; esophageal disconnection, sagging, or the appearance of a visible blind-ended pouch, and disappearance of the stomach bubble. Three cases (6.67%, 3/45) were diagnosed accurately by prenatal ultrasound, while 45 cases (100%, 45/45) were diagnosed accurately by MRI after prenatal ultrasound suggested EA. The incidences of complex cardiovascular malformation, low birth weight ( &lt; 1200 g), EA type (type I), hypoproteinemia, and an esophageal deletion length &gt; 5 cm were significantly higher in the poor prognosis group than those in the better prognosis group ( P &lt; 0 05). Conclusions Due to interference factors such as fetal movement, excessive skin thickness, skeleton, and surrounding tissues and organs, only 6.67% of types I and III EA were directly diagnosed by prenatal ultrasound in the present study. The risk factors for poor prognosis of EA were complex cardiovascular malformation, low birth weight, EA type, hypoproteinemia, and esophageal deletion length &gt; 5 cm; when these ultrasound features were found, performing MRI to diagnose EA and predict prognosis was valuable.

Diagnosis of Fetal Esophageal Atresia by Prenatal MRI and Analysis of Prognostic Factors

Objective To investigate the value of prenatal ultrasound and MRI in the diagnosis of types I and III fetal esophageal atresia (EA), in addition to analyzing the factors related to prognosis. Methods The clinical data regarding six cases of type I and 39 cases of type III EA, with the diagnosis confirmed by postnatal autopsy, MRI, CT, or surgical operation from November 2012 to January 2018, were retrospectively analyzed. Moreover, the prenatal ultrasound and MRI features were summarized. According to the prognosis, 45 fetuses with EA were divided into study (poor prognosis) and control (better prognosis) groups. Logistic regression was used to analyze the prognostic factors. Results The imaging features of 45 EA cases were as follows: Ultrasound features of fetal EA: polyhydramnios (AFI ≥ 25), continuously absent stomach bubble (rechecked 48 hours later), and reduced or no fetal swallowing over 30 minutes; the measured values for fetal head circumference (HC), abdominal circumference (AC), and estimated fetal weight (EFW) were lower than expected according to the clinical gestational age. MRI features: appearance of line-like long T1 and long T2 signals from the fetal neck to the esophagus at the upper mediastinal spinal anterior area; esophageal disconnection, sagging, or the appearance of a visible blind-ended pouch, and disappearance of the stomach bubble. Three cases (6.67%, 3/45) were diagnosed accurately by prenatal ultrasound, while 45 cases (100%, 45/45) were diagnosed accurately by MRI after prenatal ultrasound suggested EA. The incidences of complex cardiovascular malformation, low birth weight ( &lt; 1200 g), EA type (type I), hypoproteinemia, and an esophageal deletion length &gt; 5 cm were significantly higher in the poor prognosis group than those in the better prognosis group ( P &lt; 0 05). Conclusions Due to interference factors such as fetal movement, excessive skin thickness, skeleton, and surrounding tissues and organs, only 6.67% of types I and III EA were directly diagnosed by prenatal ultrasound in the present study. The risk factors for poor prognosis of EA were complex cardiovascular malformation, low birth weight, EA type, hypoproteinemia, and esophageal deletion length &gt; 5 cm; when these ultrasound features were found, performing MRI to diagnose EA and predict prognosis was valuable.

Esophageal atresia: Associated anomalies, mortality, and morbidity in Jordan.

Esophageal atresia is a developmental disorder in which the upper and lower esophagus fail to connect. It has an estimated prevalence of 1 in 2,500-4,500 live births and has poorer outcomes in low- and middle-income countries than in high-income countries. This study focused on the disorder's epidemiology, morbidity, and mortality in Jordan to address the lack of data regarding esophageal atresia in this country. This was a retrospective study covering a 16-year period at a tertiary care academic hospital. Data were extracted from archived medical records and operative notes. All patients who had complete congenital esophageal atresia data were included. In total, the records of 55 patients were analyzed. Of the included patients, 9% were diagnosed prenatally and 47% were diagnosed with polyhydramnios. The mean gestational age was 37weeks, the mean birthweight was 2,550g, and 60% of patients were male. Isolated cases of esophageal atresia were reported in 58.2% of patients. There was a high rate of associated congenital anomalies (41.8%), with cardiac lesions the most common (20%), and 5.5% were syndromic. Parental consanguinity was found in 18.2% of patients. Postoperative surgical-related morbidities included stricture (18/24; 75%) and leakage (5/24; 20.8%). Fistula recurrence occurred in one patient (4.2%). The mortality rate was 12.8%. Esophageal atresia causes a high rate of mortality and exhibits post-operative morbidities. Moreover, associated anomalies were frequently observed. A high level of the malformation was found among offspring from consanguineous marriages.

Early Management of Esophageal Leak in Esophageal Atresia: Changing Paradigms.

Introduction: A leak at the esophageal anastomosis can occur in 10%-20% of cases of esophageal atresia (EA). Thoracoscopic repair is trans-pleural, with the potential development of an empyema. Standard treatment of an anastomotic leak in a stable patient is often nonoperative, which can lead to prolonged parenteral nutrition and hospitalization. Our objective is to show that early thoracoscopic redo anastomosis management is safe and feasible. Materials and Methods: Retrospective study of a case series of four infants, diagnosed with EA and treated with early thoracoscopic esophageal leak repair between 2013 and 2018. Variables analyzed included age, weight, type of EA, day of leak, surgical approach, time to start feeding, surgical complications, and follow-up. Results: Three patients were type III, and one was type I originally repaired with a thoracoscopic approach. Leaking of the anastomosis was found the second postoperative day in one patient, third day in two patients, and the fifth day in the last one. All were confirmed with an esophagogram. All patients were operated in the first 24 hours after diagnosis by the thoracoscopic approach. The site of leak was found and re-sutured. Patients started feeding between the third and fourth day through a transanastomotic tube, starting oral feeding at the seventh day after an esophagogram did not show a leak. No complications were found. Mean time to complete oral feeding was 10 days. Two patients needed esophageal dilations. Mean time of follow-up has been 33 months. Conclusion: Early thoracoscopic repair of an anastomotic leak can be considered an alternative to the standard nonsurgical management. The early re-suture of the area of leak is a change in paradigm, but it offers the benefits of preservation of the native esophagus, early resumption of enteral feedings, and a shorter length of parental nutrition and hospitalization. Level of Evidence: IV.

Magnamosis for esophageal atresia is associated with anastomotic strictures requiring an increased number of dilatations

Background/PurposeMagnamosis is a novel technique which utilizes high power magnets to anastomose the esophageal ends in children with esophageal atresia (EA) with or without a tracheoesophageal fistula (TEF), theoretically avoiding the need for thoracotomy. The objective of this study was to compare anastomotic stricture formation requiring dilatation after magnamosis versus after conventional anastomosis. MethodsOur center treated the first 3 cases of EA ± TEF with magnamosis in Canada. One was unsuccessful and excluded from our study. The number of postintervention dilatations was compared to controls from our database, which includes all children with EA ± TEF treated between 1991 and 2015. The controls had EA ± TEF treated with pouch-to-end anastomosis or colonic interposition (n = 65). Mann–Whitney U tests were used with p < 0.05 being significant. ResultsThe 2 magnamosis cases had a mean of 13.5 dilatations, compared to 2.6 for the controls. Those managed with pouch-to-end anastomosis or colonic interposition had a mean of 2.3 and 2.7 dilatations, respectively. We found that the cases required more dilatations than controls (p = 0.022) and pouch-to-end anastomosis (p = 0.021), but not than colonic interposition (p = 0.106). ConclusionOur results indicate that magnamosis is associated with more postintervention dilatations than conventional anastomotic techniques, suggesting that magnamosis results in more frequent and/or more resilient anastomotic strictures. Level of evidence3

Rare clinical case of esophageal atresia in a newborn

Esophageal atresia is a malformation in which the upper and lower segments of the esophagus are separated. In this case, one or both segments may have a connection with the trachea.Purpose: to familiarize medical practitioners with a rare clinical case of esophageal atresia. The clinical variant of esophageal atresia presented in the publication has not yet been described in the medical literature; according to the clinical characteristics, it is most consistent with type 3B according to the classification of E. Vogt. Diagnosis and treatment of this malformation is carried out according to the previously developed standard protocol for diagnosis and treatment. The key diagnostic method is thoracoscopy, in many cases the malformation is detected intraoperatively (the main diagnostic method).The history of a sick child, a characteristic of clinical symptoms, data of paraclinical research methods, methods and favorable treatment results are provided.

Outcome of declined neonatal surgical referrals at Cairo University Specialized Pediatric Hospital

BackgroundThe combination of a high birth rate and limited resources leads to a strain on health services with dire consequences to the patient. This study aimed to track the outcome of declined referrals at the tertiary center in the Cairo University Specialized Pediatric hospital. MethodsData were collected prospectively on all declined surgical neonates at the tertiary center. The families were later contacted to document outcomes. Verbal consent was taken. FindingsOver a 12 month period from January 2017 to December 2017, 668 neonatal surgical referrals were received. Of these 278, (41·6%) were declined for lack of available places. The majority were cases of esophageal atresia with tracheoesophageal fistula (35%), followed by bowel obstruction (21%). Thirty-six cases were lost to follow up. Of the remaining 242 cases, 103 (42·5%) died, 63 (26%) were referred to public hospitals, 69 (28·5%) to private hospitals and seven (2·8%) were managed conservatively. ConclusionsNearly half of neonatal surgical cases die while waiting for surgical intervention. Cases were shared equally between the public and private sector. The collected data are crucial in planning service provision for neonates requiring surgical treatment. To the best of our knowledge, this is the first study from Egypt and the region to report the number and outcome of surgical neonates who do not get access to expert surgical services. The study outlines the burden of disease faced by a single pediatric surgery unit and documents the various congenital anomalies encountered as well as their outcome when treated elsewhere. Study typePrognosis study. Level of evidenceIV

A prospective study outcome of surgical intervention of EA and TOF in neonate coming to paediatric surgery division of general surgery at my hospital, Indore

Background: Esophageal atresia (EA) with or without Tracheoesophageal fistula (TEF) is most common congenital anomalies encountered in pediatric surgery and the management of these neonates require high degree of skill, manpower and tertiary care. This clinical study was undertaken to evaluate the outcome and postoperative complication of Esophageal atresia (EA) with or without Tracheoesophageal fistula (TEF) admitted in pediatrics surgery in M.Y. Hospital Indore.Objective: The aims of this study cases of EA and TEF regarding management and outcome.Methods: This prospective study included 220 patients of EA with TEF were enrolled in this study from Sep. 2016 to august 2018 who underwent surgical intervention. Their clinical profile, time of presentation, sex distribution, birth weight, type of EA and TEF and their effect on mortality and morbidity were observed.Results: Mortality was high (68.42%) among patients who reached the tertiary centre late i.e. >24 hours. The incidence of low birth weight babies is approximately 74% and mortality rate increased with low birth weight. EA with or without TEF More common in male then female but survival rate was high in female (71.60%). Type C was the most common (71.42) followed by type A. Septicemia and leak were most common complication. The mortality in septicemia patients is high 90.66%. Early surgical intervention improved the survival of EA and TEF. The overall survival rate was 48.63% and mortality was 51.36%. Conclusions: Esophageal atresia (EA) with Tracheoesophageal fistula (TEF) is the most common type of anomaly. Maturity, birth weight, early diagnosis are the most important factors that affect the outcome. Remarkable success has been achieved based on improvement in neonatal anesthesia & surgical technique, ventilator support & neonatal intensive care.

Likelihood of meeting defined VATER/VACTERL phenotype in infants with esophageal atresia with or without tracheoesophageal fistula.

Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is a foregut defect that is a major component of the VATER/VACTERL association. The specific diagnostic criteria for the VATER/VACTERL association phenotype have changed over time. The current definition is presence of at least three of the following: Vertebral defects, Anal atresia, Cardiac defects, TE fistula, or Renal and Limb anomalies in the absence of a specific genetic diagnosis. Using the Texas Birth Defect Registry, 1,175 cases of EA+/-TEF (174 EA; 1,001 EA + TEF) were evaluated against strict definitions of VATER/VACTERL. Nine (5.2%) cases of EA alone and 164 (16.3%) cases of EA + TEF met criteria for a diagnosis of VATER; and 20 (11.5%) and 223 (22.2%), respectively, met criteria for VACTERL. Trisomy 21, Trisomy 18, 22q11 deletion, and CHARGE were the most common syndromic diagnoses. About 88.5% (154) cases of EA and 77.8% (778) cases of EA + TEF were likely not to meet the criteria for VACTERL. EA+/-TEF is more likely to be an isolated defect or part of a multiple malformation syndrome in a pattern other than VACTERL, than be part of the defined association. This study reinforces the need to consider broader evaluation for alternate diagnoses in the presence of these defects.

The relationship between oxidative stress markers in exhaled breath condensate and respiratory problems in patients with repaired esophageal atresia

AimTo evaluate the relationship between respiratory problems and oxidative stress markers in exhaled breath condensate (EBC) of patients with esophageal atresia (EA). MethodsEA cases with respiratory problems were evaluated retrospectively for age, gender, the type of atresia, surgical treatment, outcome and respiratory symptoms. The results of gastroesophageal reflux (GER) treatment including the use of proton pump inhibitor (PPI) and fundoplication were also documented. EBC samples of 500–1000 μl were obtained by Ecoscreen machine in all cases. The levels of Glutathione (Glut), 8-isoprostane (8-iso), cysteinyl-leukotriene (Cys-LT) were measured with ELISA. Results were compared with healthy control subjects (CG, n = 26) and the relationship between oxidative stress markers and respiratory symptoms was evaluated. The results of GER treatment and oxidative stress markers in EBC were also correlated. ResultsTwenty-nine patients with a mean age of 8.8 years (3–14 years) were included. The male/female ratio was 16:13. The EA presented with distal fistula in 27 cases. While no fistula was observed in 1 case, both proximal and distal fistulae were present in another single case. Associated anomalies, most of which were cardiovascular anomalies, were observed in 65.5% (n = 19) of cases. The median Glut level was 1.03 mM/ml (0.93–1.15), iso-8 was 38.8 pg/mL (32.03–76.2) and Cys-LT was 0.44 pg/mL (20.17–61.3) in patients with EA. The median levels of oxidative markers in CG were 1.23 mM/mL (1.13–1.36), 66.3 pg/mL (33.5–106.7), and 56.9 pg/mL (27.4–80.1), respectively. Glut levels were significantly lower in EA cases compared to CG (p = 0.01). There was no significant difference between the groups regarding 8-iso and CYS-LT levels (p = 0.9, p = 1.0). Cys-LT levels were significantly lower in patients with PPI treatment [21.7 pg/mL (18.6–48.1)], when compared to patients without PPI treatment [41.1 pg/mL (22.5–83.1)] (p = 0.04) and healthy subjects [56.9 pg/mL (27.4–80.1)] (p = 0.017). The 8-iso levels were significantly decreased in cases with fundoplication compared to the patients without fundoplication (p = 0.02). ConclusionGlut – an antioxidant agent – levels were significantly lower in EBC of EA cases. The decrease in Cys-LT levels in cases with PPI treatment and in 8-iso levels in patients with fundoplication suggests that the oxidative damage in EBC of EA cases may be correlated with GER and its management. Type of studyCase control study Level of evidenceLevel III

Prospective evaluation of clinical outcomes and quality of life after gastric tube interposition as esophageal reconstruction in children.

Few studies on gastric tube interposition for esophageal reconstruction in children have assessed the long-term outcomes and quality of life (QoL). The aim of this study is to evaluate the long-term outcomes and QoL after a gastric tube interposition by reviewing our experiences with esophageal reconstruction.Twenty-six patients were included who underwent gastric tube interposition from 1996 to 2011 at our institution. We reviewed the medical records and conducted telephone surveys, prospectively performed esophagography, endoscopy, 24-hour pH monitoring, and esophageal manometry. The median follow-up period of 12 (range, 3–18) years.Median age at the time of surgery and survey were 9 (range, 2–50) months and 12.4 (range, 3.1–19.0) years, respectively. There were 14 cases of reoperation of gross type C and B esophageal atresia (EA) and 10 cases of long gap pure EA. The z scores of anthropometric data at the survey did not increase after the operation. Severe stricture in esophagography was observed in 20% of patients, but improved with balloon dilation with intact passage. Gastroesophageal reflux was able to be treated with medications. Esophageal peristalsis was observed in 1 of 8 patients in manometry. No Barrett esophagus or metaplasia was not found from endoscopy. QoL was similar to the general population and did not differ between age groups.Gastric tube interposition could be considered for esophageal reconstruction in pediatric patients when native esophageal anastomosis is impossible. Nutritional evaluation and support with consecutive radiological evaluation to assess the anastomosis site stricture are advised.

Predictive factors affecting the prognosis and late complications of 73 consecutive cases of esophageal atresia at 2 centers.

While the diagnosis and outcomes of esophageal atresia (EA) have improved, associated anomalies, the management of late complications and growth remain major issues. We analyzed factors that affected the prognosis, late complications and growth. We retrospectively reviewed EA patients treated at two centers from 1984 to 2016. Patient characteristics, complications (gastroesophageal reflux [GER], anastomotic stenosis, tracheomalacia, dysphagia) and growth were evaluated. Seventy-three EA patients were treated (overall survival rate:80.8%). The mean birth weight was 2514 ± 509g in the surviving group, and 2453 ± 567g in the fatal group excluded chromosomal abnormality (p = 0.76). Cardiac and chromosomal anomalies significantly affected mortality. Postoperative GER and anastomotic stenosis each occurred in 39% of the patients. Only GER was significantly affected by the Gross classification. The standard deviation (SD) values of the EA patients' growth were all lower than in the normal population. The SD of body weight was significantly lower in patients with extremity anomalies. Associated cardiac and chromosomal anomalies significantly affected the prognosis. GER and anastomotic stenosis were the most common late complications. The growth of the surviving cases was insufficient. These factors will help optimize the therapeutic strategies and postoperative management for EA.

Chylothorax mimicking as anastomotic leak in a case of esophageal atresia

Chylothorax, as a complication of surgery for esophageal atresia (EA), is rare. It can be misdiagnosed as reflux of milk into the chest cavity. Here, we present a case of EA complicated by chylothorax. A preterm neonate with anorectal malformation and EA (Gross type C) underwent high sigmoid colostomy and posterolateral thoracotomy. Intraoperatively, the baby was found to have a wide gap between the upper and lower end of the esophagus not amenable to primary repair. The lower esophageal end was closed using 4-0 vicryl interrupted sutures. The cervical esophagostomy, feeding gastrostomy, and chest tube insertion were done. The chest tube started draining milky fluid 2 days after starting gastrostomy feeds. It was suspected to be lower esophageal stump blow-out with reflux of gastrostomy feeds onto the chest cavity. Dye study and biochemical analysis of pleural fluid helped to make the correct diagnosis of chylothorax. Successful conservative management of chylothorax was done. In conclusion, chylothorax can mimic as anastomotic leak or reflux of gastric contents into the chest cavity and should be kept in differential diagnosis after surgery for EA. Pleural fluid analysis showing lymphocytic predominant fluid with high fluid/serum triglyceride ratio can clinch the diagnosis.

Case report on Tracheoesophageal Fistula with review of current literature

Major structural anomalies occur in 2-3% of live births all around the World. The reported global incidence of tracheoesophageal fistula (TEF) is roughly 1 in 2,500 live births varying by region. In Pakistan, incidence is reported only by those tertiary care centers that have pediatric surgery facilities available, making it an underreported and often mismanaged condition. We report a case of esophageal atresia (EA), rectovaginal fistula and tracheoesophageal fistula associated with Meconium Aspiration Syndrome (MAS) in an infant. The baby was 2 days old when she arrived at our center, born at 34 weeks, and weighed 2.3 kilograms. There was no significant antenatal history except that the mother was on antihypertensive drugs. The baby had an Apgar score of 3 and 4 at 1 and 5 minutes respectively, severe respiratory distress and cyanosis. Her chest examination revealed subcostal and intercostal recessions, bilateral crepitation and tachycardia at 180/minute. She was immediately put on ventilator and required frequent suctioning due to excessive secretion, developed abdominal distension, and had multiple episodes of desaturation and cyanosis. Complete blood picture showed leukocytosis and arterial blood gases signifying metabolic acidosis. Upon trying to pass to a catheter, baby passed stool through vagina. Contrast esophagogram showed evidence of distended stomach and proximal small bowel loops. No evidence of air was seen in the rectum. On passing the nasogastric tube into the esophagus, it curled on itself at D4 level with evidence of blind-ending proximal esophageal pouch that dilated with contrast medium. On 10th day of life baby’s condition deteriorated despite all efforts. Eventually she stopped breathing, her pupils dilated and all efforts to resuscitate her failed. This report highlights the importance of thorough clinical examination and availability of support facilities in a pediatric unit. TEF/EA should be suspected in any newborn who presents with respiratory distress, drooling, history of polyhydramnios with an inability to pass nasogastric tube. The parents should also be counselled as TEF/EA carries a 1% risk of recurrence.

Esophagoesophagopexy technique for assisted fistulization of esophageal atresia.

We describe our experience using a modified suture fistula technique for addressing tension in longer gap esophageal atresia (EA). Esophagoesophagopexy (EEP) is the tacking of the proximal and distal ends of esophageal pouches without formal anastomosis. In this retrospective cohort, we review the outcomes of patients with EA after EEP. We reviewed the operative reports of EA cases treated at our institution from 1997 to 2016 and identified all patients described as having EEP. Of 129 EA cases, five patients underwent EEP. Formal anastomosis was not done due to patient's instability, prematurity, or long gap. Median birth weight was 1.4kg (0.6-2.2kg), and median gestational age at birth was 29weeks (25-34 weeks). Age at time of EEP ranged 0-5 months. Esophagoesophageal fistula was confirmed in three patients. All three had strictures requiring weekly dilations. One of these patients died. The two surviving patients underwent fundoplication. We describe an alternative technique for esophageal anastomosis in patients for whom a standard anastomosis is not possible. EEP can lead to a functional anastomosis through fistulization and avoid the morbidity of multiple thoracotomies and lengthening procedures. Families should be educated on the potential need for dilations and antireflux procedures.

Thoracoscopic Esophageal Atresia Repair in Pakistan: Early Learning Curve

Background: Esophageal atresia is rare congenital anomaly, which is traditionally repaired by open thoracotomy. Thoracoscopic esophageal atresia repair has evolved as an effective and safe technique.Material and Methods: This is a retrospective review of 11 cases of esophageal atresia (type C), between June 2015 to May 2016. The objective of study is to describe our initial learning curve of thoracoscopic esophageal atresia repair.Results: Out of 11 patients, initial 4 underwent video assisted technique through single incision of 2 cm to visualize the exact video-scopic anatomy and to do few steps if possible. In last 7 cases, steps were completed with both ends mobilization and intracorporeally single layer interrupted stitching of esophagus. Complications encountered in 3 patients like esophageal leak in one managed conservatively, stenosis and reflux in one patient each.Conclusion: Thoracoscopic esophageal atresia repair is challenging and demanding surgery. Every surgeon has a learning curve before successful thoracoscopic repair which requires skills and learning under supervision of experienced surgeons.

Esophageal atresia and Tracheoesophageal fistula with associated anomalies in a tertiary care hospital of north India

Background: Esophageal atresia (EA) with or without Tracheoesophageal fistula (TEF) has been described as the epitome of pediatric surgery and the management of these neonates require high degree of skill, manpower and tertiary care. This clinical study was undertaken to identify the EA and TEF cases along with the pattern of associated anomalies causing mortality in Varanasi .Methods: This prospective study included 53 patients of EA with TEF who underwent primary esophageal anastomosis. Their clinical profile, time of presentation, various associated anomalies, sex distribution, and their effect on mortality and morbidity were observed.Results: Mortality was high (41.64%) among patients who reached the tertiary centre late i.e. &gt;24 hours. The incidence of low birth weight babies is approximately 75% and mortality rate increased with low birth weight. Almost 2/3 of patients had clinical or radiological evidence of pneumonia. The mortality was very high in severe pneumonia 66.7% as compared to 15% patients without pneumonia. Septicaemia and leak were most common complications. The mortality in septicemic patients is high (77.8%). The overall incidence of associated anomalies was 47%. Early surgical intervention improved the survival of EA with TEF with major GIT associated anomalies. The overall survival rate was 60.37% and mortality was 39.67%.Conclusions: Although we have improved a lot in managing these cases of EA with TEF, but we have to do much more to achieve our goal of near 100% survival.

Esophageal atresia with tracheoesophageal fistula: A rare variant and cautionary tale

Abstract Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) are relatively common congenital anomalies. Additional variants of these anomalies have been reported, including EA-TEF associated with congenital esophageal stenosis (CES) and a few reports of EA-TEF associated with an esophageal web or membranous diaphragm. We report an extremely rare case of EA with distal TEF associated with both a CES and a separate esophageal web distal to the TEF. EA-TEF with an associated CES and/or mucosal web distal to the TEF presents both a diagnostic and management challenge, as the standard diagnostic/pre-operative work-up may not identify the distal areas of esophageal occlusion. Surgeons should be aware and should maintain a high index of suspicion for these anatomic variants as they can lead to operative complications. Use of a tube to confirm patency of the distal esophageal pouch as a standard technique during EA-TEF repair may help avoid the potential pitfalls associated with failure to recognize these conditions.