Repair Of Congenital Esophageal Atresia Research Articles

Routine Fogarty Catheter Occlusion of Fistula in Esophageal Atresia with Tracheoesophageal Fistula Surgery: A Retrospective Study

Objective: We aimed to analyze the outcomes of patients who underwent surgical repair of congenital esophageal atresia (EA) with a distal tracheoesophageal fistula (EA/TEF) or a Gross type C with successful routine Fogarty catheter occlusion of TEF. Materials and Methods: We retrospectively reviewed the medical records of patients who underwent surgical repair of Gross type C with successful routine Fogarty catheter occlusion of fistula between April 2010 and November 2016. Results: Nineteen patients were enrolled and included for analysis. Mean gestational age was 38.7 (1.9) weeks with 2 (10.5%) neonates born prematurely. Mean birthweight was 2569.3 (425.3) g. Five (26.3%) patients required mechanical ventilation (MV) before surgical repair of TEF. Median post-operative required MV after TEF surgery was 4 (3-6) days. The most common of post-operative complications were wound dehiscence (10.5%) and pneumothorax (10.5%). Long-term complications were gastroesophageal reflux disease (36.8%) and tracheomalacia (31.6%). Conclusion: The success rate of routine TEF occlusion with a Fogarty catheter was 86.4%. Routine Fogarty catheter occlusion of TEF can be used safely with experienced personnel, low incidence of aspiration and satisfied ventilation. There was no serious complication associated with placement of Fogarty catheter or catheter dislodgement, and it did not occur during any of the procedures.

Preservation of the azygos vein versus ligation of the azygos vein during primary surgical repair of congenital esophageal atresia

Preservation of the azygos vein versus ligation of the azygos vein during primary surgical repair of congenital esophageal atresia

Feasible techniques in robotic thoracoscopic repair of congenital esophageal atresia: case report and literature review

BackgroundRobotic repair for esophageal atresia (EA) using da Vinci system is challenging. Specific surgical techniques need to be explored to overcome the current hurdles.Case presentationTwo cases with EA (type I and type III by Gross classification, respectively) were repaired using da Vinci robotic system. Step trocar insertion and asymmetric ports distribution techniques were used. The mean weight was 3.2 kg. Operative times were 95 min totally, with the anastomotic time of 27.5 min. Follow-up duration was 12 months. Esophageal fistula reoccurred in one case. None was confirmed anastomotic stricture.ConclusionStep trocar insertion procedure and asymmetric ports distribution technique are effective in robotic esophageal atresia.

Novel approach for the dissection of upper pouch during primary repair of esophageal atresia with tracheoesophageal fistula: Technique and results

BackgroundWe describe a technical modification to approach for dissection of proximal pouch in patients undergoing the primary repair of congenital Esophageal atresia with tracheoesophageal fistula (EA-TEF). MethodsA prospective comparative study was performed from January 2016 to December, 2019 including the patients who were undergoing primary repair of EA-TEF (Type C). The patients were divided into Group A (upper pouch dissection by classical approach) and Group B (technical modification). The two groups were compared for operative outcome and complications. Modified OSATS score was used to rate the performance of operators in two groups and were compared. ResultsTotal of 70 patients were included. In Group B, the mean operating time was less compared to Group A. The incidence of tracheal injury was also less when compared to previous data (p = 0.042). Mean OSATS score for flow of operation and overall performance was better in Group B (p = 0.002, p = 0.005). The OSATS score was also better for fifth and seventh case in Group B, proving its faster learning by trainee fellows. ConclusionThe technical modification decreases chances of tracheal injury and shortens the learning curve for upper pouch dissection. Level of evidenceLevel III.

Open Surgical Repair of Congenital Esophageal Atresia and Tracheoesophageal Fistula by Azygos Spring versus Classic Repair

Open Surgical Repair of Congenital Esophageal Atresia and Tracheoesophageal Fistula by Azygos Spring versus Classic Repair

Feeding difficulties and coping strategies of mothers with children who had radical repair of congenital esophageal atresia

Feeding difficulties and coping strategies of mothers with children who had radical repair of congenital esophageal atresia

Repair of congenital esophageal atresia with tracheoesophageal fistula repair in Ontario over the last 20years: Volume and outcomes.

This study was designed to determine the volume, postoperative surgical outcomes and, if possible, the relationship between outcome and institutional / surgeon volume in neonates undergoing repair of esophageal atresia with tracheoesophageal fistula (EA-TEF) over the last 20years in Ontario. Using administrative databases, a population based cohort study of patients undergoing EA-TEF repair in Ontario between 1993 and 2012 was conducted. 465 patients with the diagnosis of EA-TEF met inclusion criteria. The mean number of EA-TEF repairs per year per was 5.8. There was a significant difference in hospital annual volume between institutions (range 12.3-3.35: p<0.05). The average number of cases/surgeon for the last 10 study years ranged between 0.5 and 2 cases/year. Primary outcome revealed that repair of recurrent fistula or intestinal interposition was 5.3%, with no reportable difference between institutions. Secondary outcomes revealed that 45.6% underwent dilatation for esophageal strictures, and 19.8% underwent some type of drainage procedure of the chest. These rates were not significantly different between institutions. This study provides insight into the outcomes following EA-TEF repair in Ontario and the difficulty in determining surgeon or institution volume outcome relationships, as both primary and secondary outcome event rates are very low. 2.

先天性食道閉鎖症術後の食道運動機能 : 第1報 臨床的検討

先天性食道閉鎖症術後の食道運動機能 : 第1報 臨床的検討

Assessment of Clinical Symptoms and Multichannel Intraluminal Impedance and pH Monitoring in Children After Thoracoscopic Repair of Esophageal Atresia and Distal Tracheoesophageal Fistula.

Motility disturbances of the esophagus and gastroesophageal reflux disease (GERD) are observed frequently in children after repair of congenital esophageal atresia with distal tracheoesophageal fistula (EA/TEF). Recently, in many pediatric surgical centers, thoracoscopic repair was introduced, which theoretically would change the postoperative course. The goal of the study was to assess physical development, disease symptoms, and GERD symptom frequency in children who underwent thoracoscopic surgery of congenital EA/TEF. The study comprised 22 children (14 boys and 8 girls), aged 16 to 79 months (average age 47.3 months) after surgery of EA/TEF. Clinical symptoms and physical development were analyzed. In 19 children, multichannel intraluminal esophageal impedance connected with pH-metry (MII/pH) was performed. In 11 patients, esophagogastroduodenoscopy with a histological study of mucosa samples was done. The most frequent symptoms were dysphagia, belching, cough and recurrent bronchitis. In 31.5% of the children, body mass deficiency was observed and in 28.6%, low body mass and short stature. Prematurity was present in half of the patients. Depending on the result of the MII/pH study, the children were divided into two groups: 10 children with GERD and 9 children without diagnosis of gastroesophageal reflux. In the 10 with GERD, acid reflux was diagnosed in 9 and non-acid reflux was diagnosed in one. MII/pH demonstrated statistically significant differences in the number of reflux episodes, reflux index, bolus exposure index, mean time of esophageal exposure and acid exposure and mean acid clearance time in children with GERD in comparison to children without this disease. In 36.4% of children who underwent endoscopy, esophagitis was diagnosed, esophageal stricture in 18% and gastric metaplasia in 9.1%. In children who underwent corrective thoracoscopic surgery of EA/TEF, GERD caused by motility disorders of the esophagus was frequently observed. These children require constant monitoring and early treatment of the complication.

Reperméation de fistule œso-trachéale dans l’atrésie de l’œsophage de type III : un diagnostic et une prise en charge difficile

Recurrent tracheoesophageal fistula (TEF) is possible after repair of congenital esophageal atresia. The frequency of recurrent TEF is observed in about 10% of the cases. Within a cohort of 67 children with type III esophageal atresia repaired between 1998 and 2009, we aimed to identify the number of children with recurrent TEF, the risk factors for this condition, and the treatment proposed. The sex ratio was 1.7. Surgery was performed between 4 and 36 hours of life. Five children (7.5%) had a recurrent TEF, usually during the first 3 months, revealed by respiratory symptoms related to feeding in some cases. We noted that recurrent TEF was more frequent with anastomotic leakage (P=0.09) or postsurgical pneumothorax (P<0.01). The diagnosis was made in four cases out of five by a methylene blue test performed during a tracheobronchial endoscopy. Surgical treatment was noted in four children, with three postsurgical secondary effects. One child was treated by endoscopy and an esophageal clip. With a median follow-up of 52 months, no recurrence was noted. The recurrence of TEF may be linked to postsurgical events. Diagnosis is not easy and treatment is not clearly codified. Endoscopic treatment may be an advantageous option to surgery, likely with less morbidity.

Esophagitis with Eosinophil Infiltration Associated with Congenital Esophageal Atresia and Stenosis

Background: The esophagus is physiologically devoid of eosinophils, so their presence would suggest some underlying pathology. The prevalence of eosinophilic esophagitis (EoE) has steadily increased in Western countries. Previous studies have described EoE in association with congenital esophageal atresia (CEA), which is the most common congenital anomaly of the esophagus. However, the association remains unclear. Methods: We performed a retrospective histological analysis examining for eosinophil infiltration in the esophagus of patients with CEA following surgical repair or congenital esophageal stenosis (CES) who underwent esophageal biopsy or surgical resection in our hospital between 2005 and 2012. Results: There were 6 patients with CEA following surgical repair or CES who had eosinophil-dominant infiltration in the esophagus. All had associated allergic disorders, including food allergies in 4. Moreover, all except for one fulfilled the histological criteria of EoE. Impairment of eosinophil infiltration and symptomatic improvement were observed in those treated with a proton pump inhibitor (PPI), either alone or in combination with steroids after esophageal dilatation. Conclusions: These findings suggest that CEA repair or CES in conjunction with allergic conditions and coexisting gastroesophageal reflux disease (GERD) may induce greater esophageal eosinophilic inflammation. In addition, esophageal dilatation followed by PPI treatment, alone or with steroids, may be a therapeutic strategy that can provide symptomatic relief by reducing eosinophilic inflammation in esophageal strictures or GERD associated with CEA or CES.

Combined free autologous auricular cartilage and fascia lata graft repair for a recurrent tracheoesophageal fistula

Repair of recurrent tracheoesophageal fistula (TEF) after repair of congenital esophageal atresia continues to be a difficult problem. The most common re-operation for a recurrent TEF involves repair via a right thoracotomy and use of a flap as interposed tissue between the closure sites. Although several materials have been reported for recurrent fistula repair, natural pedicled flaps have been used in most previous reports. The harvesting of a pedicled flap can sometimes be difficult when the patient has had multiple surgeries. In this report, the successful use of a combined free autologous auricular cartilage and free fascia lata graft repair for a complex patient with multiple recurrent TEFs is described. We believe that our technique should be considered as an approach for patients with recurrent TEF.

A Case of Esophageal Foreign Body Impaction after Congenital Esophageal Atresia Repair over 10 Years Later

Improved long-term disease prognosis has led to the otolaryngologist sometimes seeing a remote history of congenital esophageal atresia repair. We report a case of esophageal foreign body impaction with post congenital esophageal atresia repair over 10 years after the fact. A 13-year-old boy reported a globus feeling—a ‘lump in the throat’—and dysphagia after eating fried chicken. Despite diagnostic difficulty, we identified and removed a chicken bone through esophagogastroduodenoscopy 2 days later without complications. The chicken bone was 98 mm long. This impaction after such repair is due both to anastomotic stricture and to esophageal dysmotility. Such impaction is usually accidental, and its recurrence should be prevented by working with the subject and caretakers.

A New Technique in Primary Repair of Congenital Esophageal Atresia Preventing Anastomotic Stricture Formation and Describing the Opening Condition of Blind Pouch: Plus (“+”) Incision

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.

Thoracoscopic Repair of Congenital Esophageal Atresia in Infants

The aim of this study was to introduce the recent development of the one-stage esophageal anastomosis by using thoracoscopic surgery to repair neonatal esophageal atresia in mainland China. Two successful cases at the Shanghai Children's Medical Center (SCMC; Shanghai, China) are discussed. In 2007, fistula ligation and the one-stage esophageal anastomosis were performed successfully at SCMC by thoracoscopy on 2 infants with congenital esophageal atresia. The 2 male infants with type IIIB esophageal atresia weighed 2.9 and 2.4 kg and were 4 days and 8 weeks old, respectively. Upon admission, 1 infant suffered from severe aspirated pneumonia and received the corrective surgery when the infant was recovered from the pneumonia. We successfully operated on 2 infants by thoracoscopic procedures. One baby developed a stomal leak on day 3 after the operation. Using conservative management, it was completely healed 1 week later. On the postoperative day 11, he could drink without anastomotic stenosis and was subsequently discharged on the day 15 after the operation. The other baby was discharged 10 days after surgery. However, 1 month later, he was found to have anastomotic stenosis, but was relieved of it after two balloon dilations. Both of them had an adequate weight gain during the 9- and 15-month follow-up periods. In reviewing the Chinese medical literature, it indicates that there exist only two related articles reporting about 4 successful thoracoscopic esophageal anastomosis surgeries for congenital esophageal atresia. On the Chinese mainland, pediatric thoracoscopic and laparoscopic surgery were introduced at a comparatively late stage. However, this procedure has advanced rapidly in recent years. Surgeons have gained successful experience and technique in the one-stage esophageal anastomosis by thoracoscopic surgery to treat the neonate with esophageal atresia. The results are encouraging and positive.

Efficacy of postoperative elective ventilatory support for leakage protection in primary anastomosis of congenital esophageal atresia

Anastomotic complications after primary repair of congenital esophageal atresia (EA) are recognized and feared complications. A close association exists between anastomotic leakage and the tension of the anastomosis on the suture line. This study aimed to evaluate the efficacy of postoperative elective ventilation support (PEVS) under paralysis with neck flexion after primary repair of EA. Forty-two EA patients; 4 cases with type A and 38 with type C by Gross classification received primary or delayed primary anastomosis between 1979 and 2003. PEVS has been introduced in the postoperative management of all EA cases since 1998. Vecuronium bromide was administered together with fentanyl citrate for five postoperative days. Patients were retrospectively divided into two groups: with or without PEVS management. There was no difference in operation data such as gastrostomy construction, gap between esophageal upper and lower pouch, primary or delayed primary anastomosis. PEVS under paralysis with neck flexion reduced postoperative anastomotic leakages in primary anastomosis with or without a Livaditis procedure. PEVS did not adversely increase anastomotic stricture, atelectasis, severe gastro-esophageal reflux, prolong days on ventilatory support or decrease survival rate. PEVS is an effective management method to decrease anastomotic complications for EA neonates.

Mitomycin C: An Alternative Conservative Treatment for Refractory Esophageal Stricture in Children?

Mitomycin C is an antiproliferative agent that has been used successfully as an adjunct treatment in ophthalmological procedures, in the management of laryngeal and tracheal stenosis, and more recently to prevent the recurrence of caustic esophageal strictures in children. The aim of this study was to assess the efficacy and safety of local application of mitomycin C to refractory esophageal strictures in children. We performed a preliminary prospective study of local application of mitomycin C in four children, aged between 1 year and 6 years, who had refractory esophageal strictures. Two of the children presented with strictures caused by caustic ingestion and the other two children had anastomotic strictures following surgical repair of congenital esophageal atresia. The patients had required between four and ten esophageal dilations over a 5-24-month period before mitomycin C application. After an endoscopic dilation, mitomycin C was applied onto the dilation wound using a rigid endoscope. No complications were observed after the procedure. One child required a second application of mitomycin C 2 weeks after the first application because of recurrence of dysphagia. All the children remained asymptomatic and none of them required further dilation over a mean follow-up period of 24 months. Radiological control examinations revealed that there was no recurrence of the esophageal strictures and esophageal biopsies performed during follow-up showed no signs of dysplasia. Local application of mitomycin C is a potential alternative to iterative dilations, surgery, or stent placement for the treatment of refractory esophageal strictures in children. However, prospective, long-term assessment of outcomes is needed before any definitive conclusion can be drawn about the usefulness of mitomycin C in these patients.

Early enteral feeding through a trans-anastomotic tube can be beneficial following congenital esophageal atresia repair

Early enteral feeding through a trans-anastomotic tube can be beneficial following congenital esophageal atresia repair

Physical and Social Outcome of Patients More Than 16 Years After Repair of Congenital Esophageal Atresia

Physical and Social Outcome of Patients More Than 16 Years After Repair of Congenital Esophageal Atresia

Bronchoscopic Obliteration of Recurrent Tracheoesophageal Fistula in an Infant

This report describes the use of cautery and fibrin glue applied via rigid bronchoscopy to obliterate a recurrent tracheoesophageal fistula (TEF) in an infant who had undergone repair of congenital esophageal atresia and TEF without a proximal fistula on day of life (DOL) 2 by division of the TEF with end-to-end anastomosis of the esophagus. She fed uneventfully and was discharged on DOL 11. Two months later, the child began coughing while feeding, and a contrast study showed a recurrent TEF. She underwent rigid bronchoscopy and cauterization of the fistula with an insulated wire followed by application of fibrin glue. This procedure was carried out three times at weekly intervals. Feeding was accomplished via nasogastric tube. The patient continues to eat well almost 3.5 years later. Recurrent TEF may be obliterated with application of cautery and fibrin glue via rigid bronchoscopy. Thoracotomy may thereby be avoided.