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van Hal AFRL, Aanen IP, Wijnen RMH, Pullens B, Vlot J. The Value of Preoperative Rigid Tracheobronchoscopy for the Diagnosis of Tracheomalacia in Oesophageal Atresia Patients. J Pediatr Surg 2024:S0022-3468(24)00415-9. [PMID: 39089893 DOI: 10.1016/j.jpedsurg.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Oesophageal atresia (OA) is often accompanied by tracheomalacia (TM). The aim of this study was to evaluate its presence in OA patients during routine rigid tracheobronchoscopy (TBS) before primary correction and compare this to postoperative TBS and clinical signs of TM. METHODS This retrospective cohort study included patients born with OA between June 2013 and December 2022 who had received a TBS before OA correction and had been followed for at least twelve months. Definite TM was postoperatively diagnosed through TBS, and probable TM was defined as having symptoms of TM. RESULTS We analysed data from 79 patients, of whom 87% with OA type C. Preoperatively, TM was observed in 33 patients (42% of all patients), seven of whom had severe TM. Definite TM was observed in 21 patients (27%), of whom 15 had severe TM. Forty-one patients (52% of all patients) had developed symptoms of TM within twelve months, including harsh barking cough (n = 15), stridor and/or wheezing (n = 20), recurrent respiratory insufficiency (n = 11), or needing airway surgery (n = 7). The sensitivity of preoperative TBS for the presence of postoperative (definite and probable combined) TM is 50.0%, 95% CI [35.2-64.8], and the specificity 67.6%, 95% CI [51.7-81.1]. Clinical characteristics did not differ between the patients with or without postoperative TM. CONCLUSIONS More than half of the studied patients with OA experienced symptoms of TM. While preoperative TBS is routinely performed prior to surgical OA correction, its predictive value for the presence of postoperative TM remains limited. LEVEL OF EVIDENCE Level II. TYPE OF STUDY Study of Diagnostics Test.
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Affiliation(s)
- Anne-Fleur R L van Hal
- Department of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
| | - Irene P Aanen
- Department of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Bas Pullens
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - John Vlot
- Department of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
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2
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Sumida W, Yasui A, Shirota C, Makita S, Okamoto M, Ogata S, Takimoto A, Takada S, Nakagawa Y, Kato D, Gohda Y, Amano H, Guo Y, Hinoki A, Uchida H. Update on aortopexy and posterior tracheopexy for tracheomalacia in patients with esophageal atresia. Surg Today 2024; 54:211-219. [PMID: 36729255 DOI: 10.1007/s00595-023-02652-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/25/2022] [Indexed: 02/03/2023]
Abstract
Despite improving the survival after repair of esophageal atresia (EA), the morbidity of EA repair remains high. Specifically, tracheomalacia (TM) is one of the most frequent complications of EA repair. Continuous positive airway pressure is generally applied for the treatment of TM. However, surgical intervention is required against an apparent life-threatening event or inability to perform extubation for a long period. According to our review, most cases of TM showed symptom improvement after aortopexy. The ratio of the trachea's lateral and anterior-posterior diameter at the brachiocephalic artery crossing the trachea, which reflects the compression of the trachea by the brachiocephalic artery, is a good indicator of aortopexy. Our finding suggests that most TM cases associated with EA may not be caused by tracheal fragility alone, but may involve blood vessel compression. Posterior tracheopexy (PT) is also an effective treatment for TM. Recently, open or thoracoscopic PT was able to be performed simultaneously with EA repair. In many cases, aortopexy or PT is a safe and effective surgical treatment for TM with EA. Other surgical procedures, such as external stenting, should be considered for patients with diffuse-type TM for whom aortopexy and PT appear relatively ineffective.
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Affiliation(s)
- Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Akihiro Yasui
- Department of Pediatric Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masamune Okamoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Seiya Ogata
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Aitaro Takimoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shunya Takada
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoichi Nakagawa
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Daiki Kato
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yousuke Gohda
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hizuru Amano
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yaohui Guo
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
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3
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Al Shamrani A, AlShammari A, AlAlkami H, AlShanwani J, Alharbi AS. When is asthma not guilty? Int J Pediatr Adolesc Med 2021; 8:203-211. [PMID: 34401444 PMCID: PMC8356124 DOI: 10.1016/j.ijpam.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/12/2020] [Accepted: 10/18/2020] [Indexed: 11/20/2022]
Abstract
Asthma is a common childhood condition. Its prevalence in Saudi Arabia is high, increasing, and could exceed 20% at the current trajectory. Asthma is a syndrome with different clinical presentations and phenotypes. Many conditions are often misdiagnosed as asthma because they share the same symptoms, particularly coughing and shortness of breath; physical findings, such as wheezing; radiological findings, such as hyperinflation on chest X-ray; or even responses to asthma therapies, as in some patients with bronchiolitis. When treating the younger age group (>5 years old), there should be a high degree of suspicion of alternative causes when evaluating patients presenting with clinical features suggestive of asthma or patients who do not respond well to asthma therapies. This study will highlight common conditions that may mimic asthma and, as a result of incorrect treatment, unnecessarily expose patients to steroids and other therapies for extended periods. Furthermore, we seek to alert healthcare providers to common symptoms and signs that suggest a cause other than asthma and suggest when to refer the patient to subspecialists.
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Affiliation(s)
| | - Ayshah AlShammari
- Department of Pediatrics, Prince Sultan Military Medical City, Saudi Arabia
| | - Halima AlAlkami
- Department of Pediatrics, Prince Sultan Military Medical City, Saudi Arabia
| | - Jawaher AlShanwani
- Department of Pediatrics, Prince Sultan Military Medical City, Saudi Arabia
| | - Adel S. Alharbi
- Department of Pediatrics, Prince Sultan Military Medical City, Saudi Arabia
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Serrano-Casorran C, Lopez-Minguez S, Rodriguez-Zapater S, Bonastre C, Guirola JA, De Gregorio MA. A new airway spiral stent designed to maintain airway architecture with an atraumatic removal after full epithelization-Research of feasibility and viability in canine patients with tracheomalacia. Pediatr Pulmonol 2020; 55:1757-1764. [PMID: 32407602 DOI: 10.1002/ppul.24816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/30/2020] [Accepted: 05/02/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Surgical management of tracheomalacia is a challenge, with current treatments still presenting numerous complications. In the field of veterinary medicine, this same pathology is present in a significant number of dogs. For this reason, we present an experimental clinical trial performed on canines with tracheobronchomalacia, using a new atraumatic removable tracheal spiral stent (SS). Both implantation procedure and clinical improvement have been analyzed in this study. METHODS In this study, four small dogs, a mean weight of 4.89 kg and body condition scores IV-V, were included. SS was implanted by two different surgical approaches. Image and clinical follow-up have been performed during 90 days. Symptoms were evaluated from 1 to 10 every week. RESULTS This study achieved 100% technical and clinical success. Median tracheal diameters were as follows: cervical 10.85 (3.3), inlet 7.75 (2.1), and carina 7.75 (1.9) mm, and length was 77.5 (26) mm. A 12 × 10 × 100-mm SS was implanted in all cases. Goose honk cough punctuation improved from 8 to 1; also, there were important changes in exercise intolerance, a mean weight loss of 8.76%. The values of modified Karnofsky scale varied from 50 (20) before surgery to 90 (10) after 30 days of surgery. Neither granuloma tissue nor fractures of the prosthesis was observed. CONCLUSION The results in dogs are promising, and a new therapeutic alternative seems to be available for veterinarian field. The similarity of this disease between dogs and newborns suggests that this SS design can also be useful for human trials.
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Affiliation(s)
- Carolina Serrano-Casorran
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, Zaragoza, Spain.,Department of Animal Pathology, University of Zaragoza, Zaragoza, Spain.,Minimally Invasive Unit, Veterinary School of the University of Zaragoza, Spain
| | - Sandra Lopez-Minguez
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, Zaragoza, Spain.,Minimally Invasive Unit, Veterinary School of the University of Zaragoza, Spain
| | - Sergio Rodriguez-Zapater
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, Zaragoza, Spain.,Minimally Invasive Unit, Veterinary School of the University of Zaragoza, Spain
| | - Cristina Bonastre
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, Zaragoza, Spain.,Department of Animal Pathology, University of Zaragoza, Zaragoza, Spain.,Minimally Invasive Unit, Veterinary School of the University of Zaragoza, Spain
| | - Jose A Guirola
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, Zaragoza, Spain.,Interventional Radiology Department, Lozano Blesa University Hospital, Zaragoza, Spain
| | - Miguel A De Gregorio
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, Zaragoza, Spain.,Interventional Radiology Department, Lozano Blesa University Hospital, Zaragoza, Spain
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5
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Ramphul M, Bush A, Chang A, Prifits KN, Wallis C, Bhatt JM. The role of the pediatrician in caring for children with tracheobronchomalacia. Expert Rev Respir Med 2020; 14:679-689. [DOI: 10.1080/17476348.2020.1750374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Manisha Ramphul
- Queens Medical Centre, Nottingham University Hospitals, Nottingham, UK
| | - Andrew Bush
- Imperial College, London, UK
- Royal Brompton & Harefield NHS Foundation Trust, Royal Brompton Hospital, London, UK
| | - Anne Chang
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Children Centre for Health Research, Queensland University of Technology, Brisbane, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Kostas N Prifits
- Allergy - Pulmonology Unit, 3rd Dept Paediatrics, Athens University Medical School, Chaidari, Greece
| | - Colin Wallis
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jayesh Mahendra Bhatt
- Department of Paediatric Respiratory Medicine, Nottingham Children’s Hospital, Nottingham University Hospitals, Queens Medical Centre, Nottingham, UK
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6
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Wong ZH, Hewitt R, Cross K, Butler C, Yeh YT, Ramaswamy M, Blackburn S, Giuliani S, Muthialu N, De Coppi P. Thoracoscopic aortopexy for symptomatic tracheobronchomalacia. J Pediatr Surg 2020; 55:229-233. [PMID: 31826817 DOI: 10.1016/j.jpedsurg.2019.10.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/26/2019] [Indexed: 11/19/2022]
Abstract
AIM Symptomatic tracheobronchomalacia can be fatal. Successful treatment includes aortopexy. We report outcomes of the thoracoscopic approach in a single centre. METHODS All patients undergoing thoracoscopic aortopexies from 2009 to 2018 were retrospectively reviewed. Data was reported as median (interquartile range). Risk factors for subsequent tracheostomy were analyzed with logistics regression model, p < 0.05 as significant. RESULTS Twenty-one patients with mid to distal tracheomalacia (n = 17) and bronchial involvement (n = 4) were determined on bronchoscopy, tracheobronchogram, or CT thorax. Preoperative patient demographics and comorbidities, e.g., gastro-oesophageal reflux disease, prematurity, and cardiac anomalies were recorded. Indications for thoracoscopic aortopexy were apparent life-threatening event(s) (n = 14), recurrent chest infections (n = 5), and failure to wean invasive ventilation (n = 2). Thoracoscopic aortopexies (n = 20) with conversion to open (n = 1) were performed. Intraoperative bleeding (n = 2) occurred, and chest tube (n = 1) was inserted for monitoring. Intraoperative bronchoscopy (n = 17) confirmed improvement of tracheomalacia. Anesthetic time was 140 (90-160) minutes. Postoperatively, 2 patients had dehiscence of the aorta from the sternum. They underwent redo open aortopexy with posterior tracheopexy, and 1 required subsequent tracheostomy. Another 2 patients required tracheostomies. Potential risk factors for subsequent tracheostomy were investigated, and only the association of tracheobronchomalacia was close to significance (OR 16 (95% CI 0.95-267.03), p = 0.05). Follow up duration was 365 (72-854) days. Symptoms resolution occurred in n = 17 (81%) of patients. CONCLUSION Different modalities were used to delineate the site of tracheobronchomalacia and its etiology. Tracheomalacia with bronchial involvement may be a risk factor for subsequent tracheostomy. LEVEL OF EVIDENCE Level 3 (Case Series).
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Affiliation(s)
- Zeng Hao Wong
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom; Paediatric Surgery, Mount Alvernia Hospital, Singapore
| | - Richard Hewitt
- Tracheal Team, Great Ormond Street Hospital, London, United Kingdom; Department of Otolaryngology, Great Ormond Street Hospital, London, United Kingdom
| | - Kate Cross
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Colin Butler
- Tracheal Team, Great Ormond Street Hospital, London, United Kingdom; Department of Otolaryngology, Great Ormond Street Hospital, London, United Kingdom; Stem Cell and Regenerative Medicine Section, DBC, University College London, Great Ormond Institute of Child Health, London, United Kingdom
| | - Yi-Ting Yeh
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom; Paediatric Surgery, National Yang Ming University, School of Medicine, Taiwan
| | | | - Simon Blackburn
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Stefano Giuliani
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom
| | - Nagarajan Muthialu
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Paolo De Coppi
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, Paediatric Surgery, London, United Kingdom; Stem Cell and Regenerative Medicine Section, DBC, University College London, Great Ormond Institute of Child Health, London, United Kingdom.
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7
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Wallis C, Alexopoulou E, Antón-Pacheco JL, Bhatt JM, Bush A, Chang AB, Charatsi AM, Coleman C, Depiazzi J, Douros K, Eber E, Everard M, Kantar A, Masters IB, Midulla F, Nenna R, Roebuck D, Snijders D, Priftis K. ERS statement on tracheomalacia and bronchomalacia in children. Eur Respir J 2019; 54:13993003.00382-2019. [PMID: 31320455 DOI: 10.1183/13993003.00382-2019] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/16/2019] [Indexed: 01/20/2023]
Abstract
Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The evidence on diagnosis, classification and management is scant. There is no universally accepted classification of severity. Clinical presentation includes early-onset stridor or fixed wheeze, recurrent infections, brassy cough and even near-death attacks, depending on the site and severity of the lesion. Diagnosis is usually made by flexible bronchoscopy in a free-breathing child but may also be shown by other dynamic imaging techniques such as low-contrast volume bronchography, computed tomography or magnetic resonance imaging. Lung function testing can provide supportive evidence but is not diagnostic. Management may be medical or surgical, depending on the nature and severity of the lesions, but the evidence base for any therapy is limited. While medical options that include bronchodilators, anti-muscarinic agents, mucolytics and antibiotics (as well as treatment of comorbidities and associated conditions) are used, there is currently little evidence for benefit. Chest physiotherapy is commonly prescribed, but the evidence base is poor. When symptoms are severe, surgical options include aortopexy or posterior tracheopexy, tracheal resection of short affected segments, internal stents and external airway splinting. If respiratory support is needed, continuous positive airway pressure is the most commonly used modality either via a face mask or tracheostomy. Parents of children with tracheobronchomalacia report diagnostic delays and anxieties about how to manage their child's condition, and want more information. There is a need for more research to establish an evidence base for malacia. This European Respiratory Society statement provides a review of the current literature to inform future study.
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Affiliation(s)
- Colin Wallis
- Respiratory Medicine Unit, Great Ormond Street Hospital for Children, London, UK
| | - Efthymia Alexopoulou
- 2nd Radiology Dept, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Juan L Antón-Pacheco
- Pediatric Airway Unit and Pediatric Surgery Division, Universidad Complutense de Madrid, Madrid, Spain
| | - Jayesh M Bhatt
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - Andrew Bush
- Imperial College London and Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Anne B Chang
- Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.,Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | | | | | - Julie Depiazzi
- Physiotherapy Dept, Perth Children's Hospital, Perth, Australia
| | - Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Paediatric Dept, National and Kapodistrian University of Athens, Athens, Greece
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Dept of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Mark Everard
- Division of Paediatrics, University of Western Australia, Perth Children's Hospital, Perth, Australia
| | - Ahmed Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy
| | - Ian B Masters
- Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.,Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Fabio Midulla
- Dept of Paediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Raffaella Nenna
- Dept of Paediatrics, "Sapienza" University of Rome, Rome, Italy.,Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Derek Roebuck
- Interventional Radiology Dept, Great Ormond Street Hospital, London, UK
| | - Deborah Snijders
- Dipartimento Salute della Donna e del Bambino, Università degli Studi di Padova, Padova, Italy
| | - Kostas Priftis
- Allergology and Pulmonology Unit, 3rd Paediatric Dept, National and Kapodistrian University of Athens, Athens, Greece
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8
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Haveliwala Z, Yardley I. Aortopexy for tracheomalacia via a suprasternal incision. J Pediatr Surg 2019; 54:247-250. [PMID: 30518491 DOI: 10.1016/j.jpedsurg.2018.10.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Abstract
AIM Tracheomalacia is flaccidity of the tracheal wall leading to tracheal collapse, particularly on expiration. When severe it can warrant surgical intervention. Aortopexy is one surgical option and has been described using a variety of approaches. We report outcomes of aortopexy performed via a suprasternal incision in a single centre by a single surgeon. METHODS All patients undergoing aortopexy between February 2016 and May 2018 were prospectively included. Patients were managed by a multi-disciplinary team (MDT) and underwent standardized work-up, including dynamic flexible bronchoscopy (DFB) and contrast enhanced CT. Aortopexy was performed via a suprasternal skin crease incision. Surgery was guided by intra-operative flexible bronchoscopy. Data regarding pre-operative symptoms, degree of tracheomalacia, and outcomes were recorded. RESULTS Twenty-two patients were included, 18 boys, median age 5 months (range 1 month-5 years). Two aortopexy sutures were used in all cases, and three patients required an additional tracheopexy suture. Median operating time was 1 h 24 min (range 47 min-2 h 35 min). Median pre-operative tracheal collapse on DFB was 85% (range 80-95%), improving to 35% (35-80%) intra-operatively. Median length of stay was 4 days (range 1-118). CONCLUSIONS Aortopexy via a suprasternal incision is a useful treatment modality for tracheomalacia with short operating times and rapid recovery. Outcomes vary with the best results in the TOF and premature groups. Careful patient selection and MDT work-up are essential to optimize outcomes. LEVEL OF EVIDENCE Level 3 (Case Series).
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Affiliation(s)
- Zeni Haveliwala
- Department of Paediatric Surgery, Evelina London Children's Hospital, Lambeth, London, UK
| | - Iain Yardley
- Department of Paediatric Surgery, Evelina London Children's Hospital, Lambeth, London, UK.
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9
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Kamran A, Hamilton TE, Zendejas B, Nath B, Jennings RW, Smithers CJ. Minimally Invasive Surgical Approach for Posterior Tracheopexy to Treat Severe Tracheomalacia: Lessons Learned from Initial Case Series. J Laparoendosc Adv Surg Tech A 2018; 28:1525-1530. [DOI: 10.1089/lap.2018.0198] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Ali Kamran
- Department of General Surgery, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Thomas E. Hamilton
- Department of General Surgery, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Benjamin Zendejas
- Department of General Surgery, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Bharath Nath
- Department of General Surgery, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Russell W. Jennings
- Department of General Surgery, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Charles J. Smithers
- Department of General Surgery, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
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10
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Polites SF, Kotagal M, Wilcox LJ, de Alarcon A, Benscoter DT, von Allmen D. Thoracoscopic posterior tracheopexy for tracheomalacia: A minimally invasive technique. J Pediatr Surg 2018; 53:2357-2360. [PMID: 30316404 DOI: 10.1016/j.jpedsurg.2018.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tracheomalacia is the most common congenital abnormality of the trachea. Posterior tracheopexy to alleviate posterior intrusion contributing to dynamic tracheal collapse has been reported using thoracotomy or median sternotomy. Here we describe the minimally invasive operative technique of thoracoscopic posterior tracheopexy with bronchoscopic guidance. OPERATIVE TECHNIQUE After preoperative computed tomography and bronchoscopy, a right thoracoscopic approach is utilized. The esophagus is mobilized and the membranous trachea is sutured to the prevertebral fascia under direct bronchoscopic visualization. Immediate improvement in tracheal collapse is noted. No major complications are reported and length of stay is short. Aortopexy may also be required to address anterior vascular compression. CONCLUSION Thoracoscopic posterior tracheopexy is safe and feasible. Further studies with more patients and longer follow-up are needed to assess durability.
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Affiliation(s)
- Stephanie F Polites
- Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Meera Kotagal
- Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lyndy J Wilcox
- Department of Otolaryngology-Head and Neck Surgery, University Cincinnati, Cincinnati, Ohio
| | - Alessandro de Alarcon
- Department of Otolaryngology-Head and Neck Surgery, University Cincinnati, Cincinnati, Ohio
| | - Dan T Benscoter
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Daniel von Allmen
- Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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11
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Tytgat SHAJ, van Herwaarden-Lindeboom MYA, van Tuyll van Serooskerken ES, van der Zee DC. Thoracoscopic posterior tracheopexy during primary esophageal atresia repair: a new approach to prevent tracheomalacia complications. J Pediatr Surg 2018; 53:1420-1423. [PMID: 29804792 DOI: 10.1016/j.jpedsurg.2018.04.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/02/2018] [Accepted: 04/20/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Esophageal atresia (EA) is usually accompanied by some form of tracheomalacia (TM). During the early phases in life, excessive dynamic collapse of the trachea can cause a wide spectrum of symptoms ranging from mild complaints to apparent life-threatening events (ALTE's) or brief resolved unexplained events (BRUE's). Therapeutic strategies for severe TM include aortopexy to lift the anterior weakened cartilaginous rings or posterior tracheopexy of the floppy membranous tracheal intrusion. In this study, we describe the development of a new approach in which the posterior tracheopexy is performed directly during the primary thoracoscopic correction of EA. METHODS In 2017, all nine consecutive EA patients with trachea-esophageal fistula underwent a rigid tracheo-bronchoscopy (RTB) evaluation during induction of anesthesia prior to the thoracoscopic EA repair. A floppy posterior membrane was diagnosed in four patients. During the subsequent thoracoscopic procedure, the posterior membranous trachea was fixed to the anterior longitudinal spinal ligament with non-absorbable sutures. Then, the anastomosis was made between the two esophageal pouches. RESULTS On preoperative RTB, two patients had a severe (70-90%) mid-tracheal collapse of the pars membranacea and two patients had a moderate (33-40%) mid-tracheal collapse. Thoracoscopic posterior tracheopexy with two or three sutures was possible in all four patients, prior to the formation of the esophageal anastomosis. Median time per suture was 6 min (range 4-12 min). All operative procedures were uneventful. A median follow-up of 6 months (range 4-9 months) revealed that all patients showed further recovery without any TM symptoms or ALTE/BRUE. CONCLUSIONS This is the first report that introduces a new approach to thoracoscopic posterior tracheopexy during primary EA repair. We believe that this technique can prevent the potentially deleterious sequelae of mild to severe TM that may complicate the lives of EA patients. Also, a second, sometimes complex surgical procedure can be prevented as the posterior tracheopexy is performed during the primary thoracoscopic EA correction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Stefaan H A J Tytgat
- Department of Paediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands.
| | - Maud Y A van Herwaarden-Lindeboom
- Department of Paediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
| | - E Sofie van Tuyll van Serooskerken
- Department of Paediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
| | - David C van der Zee
- Department of Paediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
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12
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van der Zee DC, van Herwaarden MYA, Hulsker CCC, Witvliet MJ, Tytgat SHA. Esophageal Atresia and Upper Airway Pathology. Clin Perinatol 2017; 44:753-762. [PMID: 29127957 DOI: 10.1016/j.clp.2017.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Esophageal atresia is an anomaly with frequently occurring sequelae requiring lifelong management and follow-up. Because of the complex issues that can be encountered, patients with esophageal atresia preferably should be managed in centers of expertise that have the ability to deal with all types of anomalies and sequelae and can perform rigorous lifelong follow-up. Tracheomalacia is an often-occurring concurrent anomaly that may cause acute life-threatening events and may warrant immediate management. In the past, major thoracotomies were necessary to carry out the aortopexy. Nowadays, aortopexy and posterior tracheopexy can both be performed thoracoscopically with quick recovery.
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Affiliation(s)
- David C van der Zee
- Department of Pediatric Surgery, University Medical Center Utrecht, KE. 04.140.5, PO Box 85090, Utrecht 3508 AB, The Netherlands.
| | - Maud Y A van Herwaarden
- Department of Pediatric Surgery, University Medical Center Utrecht, KE. 04.140.5, PO Box 85090, Utrecht 3508 AB, The Netherlands
| | - Caroline C C Hulsker
- Department of Pediatric Surgery, University Medical Center Utrecht, KE. 04.140.5, PO Box 85090, Utrecht 3508 AB, The Netherlands
| | - Marieke J Witvliet
- Department of Pediatric Surgery, University Medical Center Utrecht, KE. 04.140.5, PO Box 85090, Utrecht 3508 AB, The Netherlands
| | - Stefaan H A Tytgat
- Department of Pediatric Surgery, University Medical Center Utrecht, KE. 04.140.5, PO Box 85090, Utrecht 3508 AB, The Netherlands
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13
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Muglia C, Oppenheimer J. Wheezing in Infancy: An Overview of Recent Literature. Curr Allergy Asthma Rep 2017; 17:67. [PMID: 28895039 DOI: 10.1007/s11882-017-0737-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW Wheezing in infancy is a common presentation with many potential causes. In writing this review, we sought to summarize the newest recommendations and testing available for the more common etiologies of wheezing. RECENT FINDINGS Regarding the diagnosis of asthma, the modified asthma predictive index has recently been established as a useful predictive tool. Non-breath held multidetector CT with 3D volume rendering airway images is also a newer helpful diagnostic tool for tracheomalacia due to ease of use and its 100% positive predictive value. We found vaccines have greatly reduced the prevalence of epiglottitis, while advances in surgery are improving outcomes in infants with vascular rings. Wheezing in infants is a common problem with an extensive differential diagnosis from relatively benign to life threatening. To prevent over-looking a diagnosis that potentially requires surgical correction or emergent care, we recommend a structured approach to the history and physical exam with targeted testing directed towards the most likely diagnoses as outlined in this review.
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Affiliation(s)
- Christine Muglia
- Rutgers New Jersey Medical School, The State University of New Jersey, 90 Bergen Street, Newark, NJ, 07103, USA
| | - John Oppenheimer
- Rutgers New Jersey Medical School, The State University of New Jersey, 90 Bergen Street, Newark, NJ, 07103, USA.
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14
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Deacon JWF, Widger J, Soma MA. Paediatric tracheomalacia - A review of clinical features and comparison of diagnostic imaging techniques. Int J Pediatr Otorhinolaryngol 2017; 98:75-81. [PMID: 28583509 DOI: 10.1016/j.ijporl.2017.04.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/16/2017] [Accepted: 04/18/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | - John Widger
- Paediatric Respiratory Medicine, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Child's Health, University of New South Wales, Australia
| | - Marlene A Soma
- School of Women's and Child's Health, University of New South Wales, Australia; Paediatric Otolaryngology, Sydney Children's Hospital, Randwick, NSW, Australia
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15
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Shieh HF, Smithers CJ, Hamilton TE, Zurakowski D, Rhein LM, Manfredi MA, Baird CW, Jennings RW. Posterior tracheopexy for severe tracheomalacia. J Pediatr Surg 2017; 52:951-955. [PMID: 28385426 DOI: 10.1016/j.jpedsurg.2017.03.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE In severe tracheomalacia, aortopexy addresses anterior vascular compression, but does not directly address posterior membranous tracheal intrusion. We review patient outcomes of posterior tracheopexy for tracheomalacia with posterior intrusion to determine if there were resolution of clinical symptoms and bronchoscopic evidence of improvement in airway collapse. METHODS All patients who underwent posterior tracheopexy from October 2012 to March 2016 were retrospectively reviewed. Clinical symptoms, tracheomalacia scores based on standardized dynamic airway evaluation by anatomical region, and persistent airway intrusion were collected. Data were analyzed by Wald and Wilcoxon signed-ranks tests. RESULTS 98 patients (51% male) underwent posterior tracheopexy at a median age of 15months (IQR 6-33months). Median follow-up was 5months (range 0.25-36months). There were statistically significant improvements in clinical symptoms postoperatively, including cough, noisy breathing, prolonged and recurrent respiratory infections, transient respiratory distress requiring positive pressure, oxygen dependence, blue spells, and apparent life-threatening events (p<0.001), as well as ventilator dependence (p=0.04). Tracheomalacia scores on bronchoscopy improved significantly in all regions of the trachea and bronchi (p<0.001). 9.2% had persistent airway intrusion requiring reoperation, usually with aortopexy. CONCLUSIONS Posterior tracheopexy is effective in treating severe tracheomalacia with significant improvements in clinical symptoms and degree of airway collapse on bronchoscopy. LEVEL OF EVIDENCE Level III, treatment study.
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Affiliation(s)
- Hester F Shieh
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - C Jason Smithers
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Thomas E Hamilton
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - David Zurakowski
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Lawrence M Rhein
- Department of Pulmonology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Michael A Manfredi
- Department of Gastroenterology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Christopher W Baird
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Russell W Jennings
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, United States.
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16
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Abstract
Pediatric airway surgery is a challenging field in pediatric surgery. Laryngotracheal stenosis has a variety of congenital and acquired conditions that require precise assessment and tailored treatment for each individual patient. About 90% of acquired conditions are represented by subglottic stenosis (SGS) resulting as a complication of tracheal intubation. Congenital tracheal stenosis (CTS) is a rare and life-threatening malformation, usually associated with complete tracheal rings along a variable length of the trachea. Tracheomalacia (TM) is a process characterized by flaccidity of the supporting tracheal cartilage, widening of the posterior membranous wall, and reduced anterior-posterior airway caliber. The clinical presentation can vary from almost asymptomatic patients to near fatal airway obstruction. There is considerable variation in both the morphologic subtypes and the prognosis of pediatric airway. The patients are divided into three clinical groups (mild, moderate, and severe). A further division was proposed according to the presence or absence of associated anomalies. The definitive diagnosis of pediatric airway was made by means of rigid bronchoscope and computed tomography scan with three-dimensional reconstruction (3D-CT). Rigid bronchoscopy and 3D-CT confirmed the diagnosis in all the cases. Other associated anomalies include congenital heart disease, vascular anomalies, and BPFM (maldevelopment of aerodigestive tract). After definitive diagnosis of pediatric airway lesions, surgical intervention should be considered. Surgical strategy was presented on each lesion.
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Affiliation(s)
- Kosaku Maeda
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
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17
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van der Zee DC, Tytgat SHA, van Herwaarden MYA. Esophageal atresia and tracheo-esophageal fistula. Semin Pediatr Surg 2017; 26:67-71. [PMID: 28550873 DOI: 10.1053/j.sempedsurg.2017.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Management of esophageal atresia has merged from correction of the anomaly to the complete spectrum of management of esophageal atresia and all its sequelae. It is the purpose of this article to give an overview of all aspects involved in taking care of patients with esophageal atresia between January 2011 and June 2016, as well as the patients who were referred from other centers. Esophageal atresia is a complex anomaly that has many aspects that have to be dealt with and complications to be solved. By centralizing these patients in centers of expertise it is believed that the best care can be given.
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Affiliation(s)
- David C van der Zee
- Professor of Pediatric Surgery, Dept. Pediatric Surgery, University Medical Center Utrecht, The Netherlands.
| | - Stefaan H A Tytgat
- Pediatric Surgeon, Dept. Pediatric Surgery, University Medical Center Utrecht, The Netherlands
| | - Maud Y A van Herwaarden
- Pediatric Surgeon, Dept. Pediatric Surgery, University Medical Center Utrecht, The Netherlands
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18
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van der Zee DC. Endoscopic surgery in children - the challenge goes on. J Pediatr Surg 2017; 52:207-210. [PMID: 27890314 DOI: 10.1016/j.jpedsurg.2016.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/08/2016] [Indexed: 11/25/2022]
Abstract
UNLABELLED Paediatric endoscopic surgery is greatly indebted to Karl Storz for developing paediatric endoscopic instruments. In more recent years, there is an increasing interest in endoscopic surgery in neonates. Now more complex procedures are being performed, although it will take another generation before these will be more generally applied. One of the key factors to success is training. More sophisticated training models are becoming available, allowing practicing in a safe environment before putting the procedure to practice. A key question in performing complex procedures is whether such procedures should not be concentrated into centres of expertise. Finally, a critical appraisal is warranted in regard to safety of surgery in neonates, as they fail to have cerebral autoregulation. As endoscopy may add additional risk factors, close monitoring is obligatory. LEVEL OF EVIDENCE V.
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Affiliation(s)
- David C van der Zee
- Department of Pediatric Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital, KE 04.140.5, P.O. Box 85090, 3508AB Utrecht, The Netherlands.
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19
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van der Zee DC, Bagolan P, Faure C, Gottrand F, Jennings R, Laberge JM, Martinez Ferro MH, Parmentier B, Sfeir R, Teague W. Position Paper of INoEA Working Group on Long-Gap Esophageal Atresia: For Better Care. Front Pediatr 2017; 5:63. [PMID: 28409148 PMCID: PMC5374143 DOI: 10.3389/fped.2017.00063] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/15/2017] [Indexed: 11/22/2022] Open
Abstract
INoEA is the International Network of Esophageal Atresia and consists of a broad spectrum of pediatric specialties and patient societies. The working group on long-gap esophageal atresia (LGEA) set out to develop guidelines regarding the definition of LGEA, the best diagnostic and treatment strategies, and highlight the necessity of experience and communication in the management of these challenging patients. Review of the literature and expert discussion concluded that LGEA should be defined as any esophageal atresia (EA) that has no intra-abdominal air, realizing that this defines EA with no distal tracheoesophageal fistula (TEF). LGEA is considerably more complex than EA with distal TEFs and should be referred to a center of expertise. The first choice is to preserve the native esophagus and pursue primary repair, delayed primary anastomosis, or traction/growth techniques to achieve anastomosis. A cervical esophagostomy should be avoided if possible. Only if primary anastomosis is not possible, replacement techniques should be used. Jejunal interposition is proposed as the best option among the major EA centers. In light of the infrequent occurrence of LGEA and the technically demanding techniques involved to achieve esophageal continuity, it is strongly advised to develop regional or national centers of expertise for the management and follow-up of these very complex patients.
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Affiliation(s)
| | - Pietro Bagolan
- Department of Medical and Surgical Neonatology, Newborn Surgery Unit, Bambino Gesù Children's Hospital-Research Institute Rome, Rome, Italy
| | - Christophe Faure
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
| | | | - Russell Jennings
- Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Benoît Parmentier
- Department of Pediatric Surgery, Robert Debré University Hospital, APHP, Paris, France
| | - Rony Sfeir
- Department of Surgery, Jeanne de Flandre Hospital, Lille, France
| | - Warwick Teague
- Department of Pediatric Surgery, The Royal Children's Hospital, Melbourne, VIC, Australia
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20
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van der Zee DC. New developments towards the management of severe cases of tracheobronchomalacia. J Thorac Dis 2016; 8:3484-3485. [PMID: 28149538 DOI: 10.21037/jtd.2016.12.94] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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21
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Abstract
Neonatal surgery is recognized as an independent discipline in general surgery, requiring the expertise of pediatric surgeons to optimize outcomes in infants with surgical conditions. Survival following neonatal surgery has improved dramatically in the past 60 years. Improvements in pediatric surgical outcomes are in part attributable to improved understanding of neonatal physiology, specialized pediatric anesthesia, neonatal critical care including sophisticated cardiopulmonary support, utilization of parenteral nutrition and adjustments in fluid management, refinement of surgical technique, and advances in surgical technology including minimally invasive options. Nevertheless, short and long-term complications following neonatal surgery continue to have profound and sometimes lasting effects on individual patients, families, and society.
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Affiliation(s)
- Mauricio A Escobar
- Pediatric Surgery, Mary Bridge Children׳s Hospital, PO Box 5299, MS: 311-W3-SUR, 311 South, Tacoma, Washington 98415-0299.
| | - Michael G Caty
- Section of Pediatric Surgery, Department of Surgery, Yale-New Haven Children׳s Hospital, New Haven, Connecticut
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22
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Abstract
Tracheomalacia (TM) is defined as an increased collapsibility of the trachea due to structural anomalies of the tracheal cartilage and/or posterior membrane. Tracheomalacia has a wide range of etiologies but is most commonly present in children born with esophageal atresia and tracheal esophageal fistula. Clinical symptoms can range from minor expiratory stridor with typical barking cough to severe respiratory distress episodes to acute life-threatening events (ALTE). Although the majority of children have mild-to-moderate symptoms and will not need surgical intervention, some will need life-changing surgical treatment. This article examines the published pediatric literature on TM, discusses the details of clinical presentation, evaluation, diagnosis, and a variety of treatments.
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Affiliation(s)
- Jose Carlos Fraga
- Department of Surgery, Pediatric Surgeon at Hospitals de Clinicas, Moinhos de Vento and Materno-Infantil Presidente Vargas, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos 2350, Sala 600-Porto Alegre, CEP90035-903, Porto Alegre, RS, Brazil.
| | - Russell W Jennings
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, USA, MA
| | - Peter C W Kim
- Department of General and Thoracic Surgery, Children's Medical Center, Washington University, Washington, DC
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