Surgical Treatment Of Esophageal Atresia Research Articles

Thoracic Musculoskeletal Deformities Following Surgical Treatment of Esophageal Atresia - Thoracoscopic Versus Open Approach: A Retrospective Two Centers Cohort Study

IntroductionThoracic musculoskeletal deformities are significant complications following open correction of esophageal atresia (EA) during long-term follow-up. We aimed to compare the frequency and severity of thoracic musculoskeletal deformities after open and thoracoscopic repair of EA. We hypothesized that fewer deformities would occur following the less invasive thoracoscopic approach. MethodsThis retrospective study analyzed patients treated at two pediatric surgery departments in Poland between 2005 and 2021. The patient groups differed in surgical approach, operative techniques, indications for multi-staged surgery, and postoperative complications. The study encompassed all types of EA/TEF. The first group comprised 68 patients who underwent thoracoscopic esophageal atresia repair (Wroclaw), while the second group involved 44 patients who underwent open repair (Warsaw). Clinical data were retrospectively reviewed, with results considered significant at p < 0.05. ResultsThe median age at examination was 6 years in the thoracoscopy group and 5.5 years in the thoracotomy group. In the thoracoscopy group, 53 out of 68 patients (77.9%) and in the thoracotomy group – 35 out of 44 patients (79.5%) were treated in one stage. The incidence of thoracic musculoskeletal deformities was significantly lower in the thoracoscopy group (1.5%) compared to the thoracotomy group (34.1%, p < 0.001). Scoliosis occurred significantly more often after thoracotomy (13.6% vs 1.5%, p = 0.016). There was no rib fusion (0% vs 37.1%, p < 0.001) and no scoliosis of =>20° (0% vs 6.8%, p = 0.058) after thoracoscopy. The coincidence of rib fusion and scoliosis was significant (9.1%, p = 0.022) for the open approach. In the thoracotomy group, multi-staged surgery and more frequent reoperations due to major complications were significantly associated with an increased occurrence of deformities. None of the patients after thoracoscopic multi-stage or complicated EA/TEF repair developed scoliosis. ConclusionsThe frequency and severity of thoracic musculoskeletal deformities were significantly lower after the thoracoscopic approach. Thoracoscopy may be a more advantageous and preferred surgical approach for the EA/TEF treatment, although further randomized, controlled studies are necessary. Post-thoracotomy scoliosis may progress to a severity requiring surgery.

Long-Term Outcomes and Health-Related Quality of Life in a Swiss Patient Group with Esophageal Atresia.

Surgical treatment of esophageal atresia (EA) has markedly improved, allowing the focus to shift from short-term complications and mortality to long-term complications and quality of life. Health-related quality of life (HRQoL) is variable and reported to range from reduced to unimpaired in patients with repaired EA. We assessed the HRQoL, determined the prevalence of long-term complications and their possible impact on the HRQoL in patients who had correction of EA in Switzerland. Further, we also investigated in the general well-being of their parents. Patients with EA repair in Switzerland between 1985 and 2011 were enrolled. Long-term complications were assessed by enquiring disease-related symptoms, standardized clinical examinations, and analysis of radiographs. HRQoL was inquired using different validated questionnaires (KIDSCREEN-27, World Health Organization [WHO]-5, and Gastrointestinal Quality of Life Index [GIQLI]). Patients were grouped according to their age. In underage patients, general well-being of the parents was assessed using the WHO-5 questionnaire. Thirty patients were included with a mean age of 11.3 ± 5.7 years. Long-term complications were present in 63% of all patients. HRQoL in underage patients was comparable to the provided reference values and rated as good, while adult patients reported a reduced HRQoL. The presence of gastroesophageal reflux disease symptoms was associated with reduced HRQoL in underage patients. Parents of underage patients stated a good general well-being. Long-term complications among patients with repair of EA in Switzerland are common. HRQoL in underage patients is good and general well-being of their parents is unimpaired. Adult patients reported a reduced HRQoL, consistent with other reports. As long-term complications may manifest only later in life, a structured follow-up of patients with an EA repair during childhood and adolescence is needed.

Surgical treatment of esophageal atresia with lower tracheoesophageal fistula in an extremely preterm infant (510 g, 25 + 5 weeks): a case report

BackgroundThe surgical management of esophageal atresia in extreme-low-birth-weight infants (< 1000 g) is challenging. We report on an extreme-low-birth-weight infant who was extremely preterm (510 g, 25 + 5 weeks) and of prenatally unknown Gross type C esophageal atresia.Case presentationAfter resuscitation and intubation, the tracheoesophageal fistula was closed on the first day of life in the neonatal intensive care unit via an extrapleural approach using a titanium clip. On the sixth day of life, the Caucasian child was extubated. To minimize the operative trauma in the initial neonatal period, we prolonged gastrostomy placement until the 22nd day of life (weight 725 g). At the age of 3 months (weight 2510 g), thoracoscopic esophageal anastomosis was performed. The postoperative course was unremarkable. During the further clinical course, eight esophageal dilations were necessary. Currently, the patient swallows without difficulties at the age of 4 years and thrives well [15 kg (Percentile 28); 100 cm (Percentile 24)].ConclusionsOur case shows that minimized postnatal surgical trauma with primary tracheoesophageal fistula closure at the bedside, delayed gastrostomy, and minimally invasive esophageal repair after substantial weight gain (> 2.5 kg) is a good strategy for esophageal atresia/tracheoesophageal fistula in extreme-low-birth-weight infants.

Esophageal atresia — state of the art (review of literature on the PUBMED base)

Esophageal atresia is fundamentally important in pediatric surgery, as its treatment results create an accurate portrait of the standards of surgical care, which is provided by any medical institution. Cameron Haight performed the first successful reconstruction of the esophagus malformation relatively recently just over 70 years ago. Advances in neonatal surgery, technology and advances in neonatal intensive care have dramatically improved treatment outcomes for this disease. Current mortality from this developmental abnormality has become minimal, despite its frequent association with other malformations. A revolutionary approach to the treatment of esophageal atresia was developed by Steven Rothenberg in 1999, the pioneer and legend of pediatric minimally invasive surgery. In 1999, he revolutionized esophageal anastomosis by thoracoscopy. The innovative concept of the minimally invasive approach ensured minimal trauma to patients, thereby providing the possibility of rapid postoperative recovery of patients and reducing the length of their surgical hospital stay. This literature review raises the main controversy in the surgical treatment of esophageal atresia in the 21st century. Emphasis is placed on the study of the role of minimally invasive surgery and the treatment of concomitant abnormalities associated with gastroesophageal reflux and tracheomalacia. As part of the study, a description of all the latest technologies, advances in technical and scientific terms, solutions, exceptional experience, and competence in developing and implementing minimally invasive operations in young children. These developments changed the direction of pediatric surgery and improved the quality of surgical care for children with congenital malformation of the esophagus and how they were performed.

Outcome of the surgical treatment of esophageal atresia and its associated factors among newborn at French Medical Institute for mothers and children (FMIC) Hospital Kabul Afghanistan

Outcome of the surgical treatment of esophageal atresia and its associated factors among newborn at French Medical Institute for mothers and children (FMIC) Hospital Kabul Afghanistan

Chest Physiotherapy in Newborns after Surgical Treatment of Esophageal Atresia: The Alternative of Ventilatory Support in Madagascar

Chest Physiotherapy in Newborns after Surgical Treatment of Esophageal Atresia: The Alternative of Ventilatory Support in Madagascar

Thoracic skeletal anomalies following surgical treatment of esophageal atresia. Lessons from a national cohort.

Thoracotomy as surgical approach for esophageal atresia treatment entails the risk of deformation of the rib cage and consequently secondary thoracogenic scoliosis. The aim of our study was to assess these thoracic wall anomalies on a large national cohort and search for factors influencing this morbidity. Pediatric surgery departments from our national network were asked to send recent thoracic X-ray and operative reports for patients born between 2008 and 2010 with esophageal atresia. The X-rays were read in a double-blind manner to detect costal and vertebral anomalies. Among 322 inclusions from 32 centers, 110 (34.2%) X-rays were normal and 25 (7.7%) displayed thoracic malformations, including 14 hemivertebrae. We found 187 (58.1%) sequelae of surgery, including 85 costal hypoplasia, 47 other types of costal anomalies, 46 intercostal space anomalies, 21 costal fusions and 12 scoliosis, with some patients suffering from several lesions. The rate of patients with these sequelae was not influenced by age at intervention, weight at birth, type of atresia, number of thoracotomy or size of the center. The rate of sequelae was higher following a classical thoracotomy (59.1%), whatever the way that thoracotomy was performed, compared to nonconverted thoracoscopy (22.2%; p=0.04). About 60 % of the patients suffered from a thoracic wall morbidity caused by the thoracotomy performed as part of surgical treatment of esophageal atresia. Minimally invasive techniques reduced thoracic wall morbidity. Further studies should be carried out to assess the potential benefit of minimally invasive approaches to patient pulmonary functions and on the occurrence of thoracogenic scoliosis in adulthood. Level III retrospective comparative treatment study.

Improvement of surgical treatment of esophageal atresia in newborns

Improvement of surgical treatment of esophageal atresia in newborns

Balloon or Bougienage Dilation for Esophageal Stenosis in Children?

Purpose: Esophageal stenosis (ES) in children is defined as a fixed intrinsic narrowing of the esophagus caused by numerous etiologies. Treatment mainly consists of intraluminal dilation using balloon or Savary-Gilliard bougies. Methods: We retrospectively reviewed all medical records of children with ES treated by balloon or bougies. Our aim of this study was to compare both method of esophageal dilation in terms of safety, short- and long-term outcome. Results: Forty-two children were included in this study, 22 males (52%), mean age at diagnosis was 3.9 ± 5.7 years. This group underwent 190 dilation procedures in our institution between 1994-2013. The median treatment period was 5.5 months and the median follow-up after the last dilation was 2.25 years. The average number of dilations was 4.5 (range 1-22). Twenty-four patients had anastomotic stricture after surgical treatment of esophageal atresia (57.1%), 8 had stenosis following caustic ingestion (19%), 3 had functional stenosis due to esophageal motility disorders (achalasia) (7.1%) and the others (16.7%) had congenital ES, eosinophilic esophagitis, foreign body ingestion, or were post-fundoplication. Dilations were defined as failures in 11 children (26.2%). The success rate was 87% for the bougienage group (13 children) and 67% for the balloon group (18 children) (p=NS). The success rate was 75% (24 children) after caustic ingestion and surgical correction of esophageal atresia. There were 6 (3.1%) procedure-related complications that included 2 cases of aspiration pneumonia and 4 esophageal perforations. Conclusions: Esophageal dilation in children is a safe procedure with a high rate of long-term success. Longterm success of dilation among children with ES depends primarily on the etiology of stenosis and less on the method of dilation.

Clinical characteristics and treatment of esophageal atresia: a single institutional experience

PurposeTreatment for esophageal atresia has advanced over several decades due to improvements in surgical techniques and neonatal intensive care. Subsequent to increased survival, postoperative morbidity has become an important issue in this disease. The aim of our study was to analyze our experience regarding the treatment of esophageal atresia.MethodsWe reviewed and analyzed the clinical data of patients who underwent surgery for esophageal atresia at Severance Children's Hospital from 1995 to 2010 regarding demographics, surgical procedures, and postoperative outcomes.ResultsSeventy-two patients had surgery for esophageal atresia. The most common gross type was C (81.9%), followed by type A (15.3%). Primary repair was performed in 52 patients. Staged operation was performed in 17 patients. Postoperative esophageal strictures developed in 43.1% of patients. Anastomotic leakages occurred in 23.6% of patients, and recurrence of tracheoesophageal fistula was reported in 8.3% of patients. Esophageal stricture was significantly associated with long-gap (≥3 cm or three vertebral bodies) atresia (P = 0.042). The overall mortality rate was 15.3%. The mortality in patients weighing less than 2.5 kg was higher than in patients weighing at least 2.5 kg (P = 0.001). During the later period of this study, anastomotic leakage and mortality both significantly decreased compared to the earlier study period (P = 0.009 and 0.023, respectively).ConclusionThe survival of patients with esophageal atresia has improved over the years and the rate of anastomotic leakage has been significantly reduced. However, overall morbidities related to surgical treatment of esophageal atresia still exists with high incidence.

Current Controversies in the Surgical Treatment of Esophageal Atresia

Esophageal atresia (EA) with or without tracheo-esophageal fistula (TEF) is a rare condition that can be nowadays succesfully treated. The current interest therefore is focused on the management of the difficult cases, on thoracoscopic approach, and on some aspects of the long-term results. The current strategies for the difficult or impossible anastomoses in pure and long-gap EA, the introduction of thoracoscopic repair and the causes, mechanisms and management of post-operative gastro-esophageal reflux (GER) are reviewed. Methods of esophageal elongation and multi-staged repair of pure and long-gap EA allow anastomosis but with functional results that are often poor. Esophageal replacement with colon or stomach achieves at least similar results and often requires less procedures. Thoracoscopic repair is a promising adjunct, but the difficulties for setting it as a gold-standard are pointed out. GER is a part of the disease and its surgical treatment, that is often required, is burdened by high failure rates. EA with or without TEF can be successfully treated in most cases, but a number of unsolved issues remain and the current approach to difficult cases will certainly evolve in the future.

Anastomotic stricture after surgical repair of esophageal atresia: frequency, risk factors, and efficacy of esophageal bougie dilatations

Aims The aim of this study was to evaluate the frequency and risk factors of postoperative anastomotic stricture, and the efficacy and complications of esophageal bougie dilatations for symptomatic anastomotic stricture in a population of children with esophageal atresia. Patients and Methods The medical records of 62 children operated on for esophageal atresia type III (Ladd and Gross) over a 5-year period were retrospectively reviewed. Results Anastomotic stricture developed in 23 (37%) of patients. Anastomotic tension during primary repair of esophageal atresia was associated with subsequent stricture formation ( P < .05). Patients required esophageal dilation at a mean age of 149 days (range, 30-600 days). Stricture resolution occurred after a mean of 3.2 dilatations per patient (range, 1-7). Dilation was successful in 87% of patients. Three patients continued to present mild (n = 1) to severe (n = 2) dysphagia, mainly related to esophageal dysmotility. No complications were observed during or after the dilatation sessions. Conclusions Anastomotic stricture, secondary to the surgical treatment of esophageal atresia, remains a frequent complication in patients with esophageal atresia. Esophageal dilation with Savary-Gilliard bougies is a safe and effective procedure in the management of strictures.

Long-term assessment of the treatment of recurrent tracheoesophageal fistula with fibrin glue associated with diathermy

Purpose Recurrent tracheoesophageal fistula (RTF) is a serious common complication of the surgical treatment of esophageal atresia. We report the results of our technique of bronchoscopic treatment of RTF with fibrin glue (Tissucol), with a follow-up of over 1 decade. Methods A retrospective review between 1993 and 2004 was conducted, including all patients diagnosed with RTF and treated bronchoscopically with Tissucol, with over 1 year of follow-up. The procedure was implemented under general anesthesia using a rigid neonatal bronchoscope. A magnification chamber and previous diathermia using a urethral catheter were used in the latter 4 patients. The fibrin glue was injected through a clear catheter. The number of endoscopic sessions per patient was limited to 3. Results Seven patients were treated, with evidence of fistular closure in 6 (85%). One patient with satisfactory results, but a follow-up of 4 months, was not included. The age at bronchoscopy ranged from 14 to 20 days (mean, 16.7 days), and a total of 12 sessions were required (mean, 1.7). In the latter 4 patients, diathermia was associated with good results in all and a lower number of sessions (mean, 1.5). All patients were evaluated clinically and radiologically, and a control endoscopy was performed in 4 patients. The follow-up lasted from 2 to 11 years (mean, 7.4 years). Conclusions Because we started to use Tissucol (1994), other authors have reported successful isolated cases, but a relatively large series and a long-term follow-up were lacking. We consider that the success of the procedure depends on several technical factors such as an early diagnosis, before epithelium is formed in the fistula, and the use of initial diathermia, associated in the latter 4 patients. The results obtained with 85% success with a follow-up over 1 year show that the fibrin adhesive is the reference substance for the treatment of RTF; we recommend its endoscopic application associated with diathermia as initial measure.

High-dose omeprazole in esophagitis with stenosis after surgical treatment of esophageal atresia

The authors describe 4 children with recurrent stenosis and persistent esophagitis after secondary repair of a long gap esophageal atresia. They underwent an esophageal reconstruction by elongation of the lesser gastric curvature according to Schärli at the age of 11 to 14 months. All had esophagitis grade III to IV (Savary-Miller classification), esophageal stenosis, and failure to thrive. Effective treatment of the esophagitis and prevention of stenosis consisted in high doses of omeprazole (1.9 to 2.5 mg/kg/d). After this treatment, the need for esophageal dilatation disappeared, and nutritional status normalized. J Pediatr Surg 36:1416-1418. Copyright © 2001 by W.B. Saunders Company.

先天性食道疾患 食道閉鎖症を中心に

The main congenital disorders of the esophagus requiring surgery consist of esophageal atresia and esophageal stenosis. Of these disorders, esophageal atresia is most common and one of the important diseases in the neonatal surgical field. Esophageal atresia and its similar disorders require surgery in the early neonatal period. On the other hand, esophageal stenosis which demonstrated a delayed initial symptom after the weaning period, usually underwent surgery after one year of life.During the last twenty years, surgical managements in the neonatal patients have made a rapid progress in Japan and surgical results have now been comparable to those from the advanced countries in the world.In recent years, therefore, surgical results of esophageal atresia have been improved except in high risk patients with severe anomalies, severe pulmonary complication and extreme prematurity.In this paper, the author commented on the present states of surgical treatment of esophageal atresia including its similar disorders such as isolated tracheoesophageal fistula and laryngotracheoesophageal cleft.

Esophageal atresia with tracheoesophageal fistula: Lessons of a quarter century's experience

The evolution of the surgical treatment of esophageal atresia has been traced through the past twenty-five years as reflected in a series of eighty-nine cases from Doernbecher Memorial Hospital. Emphasis has been placed on biologic and treatment factors influencing survival.

Surgical treatment of esophageal atresia and tracheo-esophageal fistula in the infant.

Surgical treatment of esophageal atresia and tracheo-esophageal fistula in the infant.

The Surgical Treatment of Esophageal Atresia and Tracheoesophageal Fistulas

The Surgical Treatment of Esophageal Atresia and Tracheoesophageal Fistulas