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Borselle D, Grochowski K, Gerus S, Międzybrodzki K, Kołtowski K, Jasińska A, Kamiński A, Patkowski D. Thoracic Musculoskeletal Deformities Following Surgical Treatment of Esophageal Atresia - Thoracoscopic Versus Open Approach: A Retrospective Two Centers Cohort Study. J Pediatr Surg 2024; 59:1719-1724. [PMID: 38594136 DOI: 10.1016/j.jpedsurg.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/07/2024] [Accepted: 03/10/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Thoracic 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. METHODS This 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. RESULTS The 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. CONCLUSIONS The 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.
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Affiliation(s)
- Dominika Borselle
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland.
| | - Konrad Grochowski
- Department of Pediatric Surgery, Pediatric Urology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Sylwester Gerus
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Krzysztof Kołtowski
- Department of Pediatric Orthopedics and Traumatology, University Hospital of Jan Mikulicz-Radecki, Wroclaw, Poland
| | - Aleksandra Jasińska
- Department of Pediatric Surgery, Pediatric Urology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Kamiński
- Department of Pediatric Surgery, Pediatric Urology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Dariusz Patkowski
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland
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Borselle D, Gerus S, Bukowska M, Patkowski D. Birth weight and thoracoscopic approach for patients with esophageal atresia and tracheoesophageal fistula-a retrospective cohort study. Surg Endosc 2024; 38:5076-5085. [PMID: 39020118 PMCID: PMC11362424 DOI: 10.1007/s00464-024-11063-8] [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: 03/14/2024] [Accepted: 07/07/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND This study aimed to analyze the results, feasibility and safety of the thoracoscopic approach for patients with esophageal atresia with tracheoesophageal fistula (EA/TEF) depending on the patient's birth weight. METHODS The study involved only type C and D EA/TEF. Among the analyzed parameters were the patients' characteristics, surgical treatment and post-operative complications: early mortality, anastomosis leakage, anastomosis strictures, chylothorax, TEF recurrence, and the need for fundoplication or gastrostomy. RESULTS 145 consecutive newborns underwent thoracoscopic EA with TEF repair. They were divided into three groups-A (N = 12 with a birth weight < 1500 g), B (N = 23 with a birth weight ≥ 1500 g but < 2000 g), and C-control group (N = 110 with a birth weight ≥ 2000 g). Primary one-stage anastomosis was performed in 11/12 (91.7%) patients-group A, 19/23 (82.6%)-group B and 110 (100%)-group C. Early mortality was 3/12 (25%)-group A, 2/23 (8.7%)-group B, and 2/110 (1.8%)-group C and was not directly related to the surgical repair. There were no significant differences in operative time and the following complications: anastomotic leakage, recurrent TEF, esophageal strictures, and chylothorax. There were no conversions to an open surgery. Fundoplication was required in 0%-group A, 4/21 (19.0%)-group B, and 2/108 (1.9%)-group C survivors. Gastrostomy was performed in 1/9 (11.1%)-group A, 3/21 (14.3%)-group B and 0%-group C. CONCLUSION In an experienced surgeon's hands, even in the smallest newborns, the thoracoscopic approach may be safe, feasible, and worthy of consideration. Birth weight seems to be not a direct contraindication to the thoracoscopic approach.
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Affiliation(s)
- Dominika Borselle
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
| | - Sylwester Gerus
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Monika Bukowska
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Dariusz Patkowski
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
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Castro P, Fall F, Pace D, Mack SJ, Rothstein DH, Devin CL, Sagalow E, Linden AF, Boelig M, Asti L, Berman L. Association of Operative Approach With Postoperative Outcomes in Neonates Undergoing Surgical Repair of Esophageal Atresia and Tracheoesophageal Fistula. J Pediatr Surg 2024:S0022-3468(24)00460-3. [PMID: 39147683 DOI: 10.1016/j.jpedsurg.2024.07.026] [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: 05/28/2024] [Revised: 07/15/2024] [Accepted: 07/18/2024] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Minimally invasive surgery (MIS) is gaining traction as a first-line approach to repair congenital anomalies. This study aims to evaluate outcomes for neonates undergoing open versus MIS repairs for esophageal atresia/tracheoesophageal fistula (EA/TEF). METHODS In this retrospective study, neonates undergoing EA/TEF repair from 2013 to 2020 were identified using the National Surgical Quality Improvement Program-Pediatric database. Proportions of operative approach (open vs. MIS) over time were analyzed. A propensity score-matched analysis using preoperative characteristics was performed and outcomes were compared including composite morbidity and reintervention rates (overall, major [thoracoscopy, thoracotomy], and minor [chest/feeding tube placement, endoscopy]) between operative approaches. Pearson's chi-square or Fisher's exact tests were used as appropriate. RESULTS We identified 1738 neonates who underwent EA/TEF repair. MIS utilization increased over time. Pre-match, neonates undergoing open repair were more likely to be premature, lower weight, ventilator dependent, and have cardiac risk factors with higher severity. Post-match, the groups were similar and included 340 neonates per group. MIS repair was associated with longer median operative time (209 vs. 174 min, p < 0.001) and increased overall post-operative intervention rates (7.6% vs. 2.9%, p = 0.01). There were no differences in composite morbidity (24.4% vs. 25.0%, p = 0.86) outside of reintervention. CONCLUSION MIS approach for neonates with EA/TEF appears to be associated with a higher rate of reinterventions. Further studies evaluating MIS approaches for the repair of EA/TEF are needed to better define short- and long-term outcomes. TYPE OF STUDY Retrospective comparative study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Paulo Castro
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States
| | - Fari Fall
- Division of Pediatric Surgery, Nemours Children's Health, Wilmington, DE, United States; Department of General Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Devon Pace
- Division of Pediatric Surgery, Nemours Children's Health, Wilmington, DE, United States; Department of General Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Shale J Mack
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, United States
| | - David H Rothstein
- Division of Pediatric Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Courtney L Devin
- Division of Colorectal Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Emily Sagalow
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, United States
| | - Allison F Linden
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine/Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Matthew Boelig
- Division of Pediatric Surgery, Nemours Children's Health, Wilmington, DE, United States; Department of General Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Lindsey Asti
- Division of Pediatric Surgery, Nemours Children's Health, Wilmington, DE, United States
| | - Loren Berman
- Division of Pediatric Surgery, Nemours Children's Health, Wilmington, DE, United States; Department of General Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
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Balubaid RN, Aljedani RS, Moglan A, Hennawi YB, Mousa AH, Alosaimi M. Prevalence of spinal deformity development after surgical management of a congenital heart disease among children: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2088-2096. [PMID: 38466435 DOI: 10.1007/s00586-023-08083-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/04/2023] [Accepted: 12/01/2023] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Open heart surgery is the most common treatment for congenital heart disease. Thoracotomy, sternotomy, or a combination of both are the main approaches used in open heart surgeries. In cardiac surgery, there have been concerns that these surgeries increase the likelihood of spinal deformities. Therefore, this systematic review and meta-analysis provided updated evidence on the prevalence of spinal deformities following congenital heart surgery. METHOD EMBASE, Medline, ScienceDirect, and Google Scholar were used to search for studies published until 2022. We include randomized clinical trials and observational studies that reported the prevalence of spinal deformities (scoliosis and kyphosis) after congenital heart surgery among participants without these deformities before surgery. Two independent reviewers independently screened literature identified from the databases. Two reviewers independently conducted screening of studies identified during the search, data extraction, and quality assessment of the included studies. RESULTS In total, 688 studies were screened; 13 retrospective and one prospective cohort studies were included, encompassing 2294 participants. The pooled prevalence of spinal deformities (scoliosis and kyphosis) after open heart surgery performed on skeletally immature patients was 23.1% (95% confidence interval [CI] = 23.1-35.3; I2 = 97.5%). CONCLUSION This review suggests that the prevalence of spinal deformities was high among patients who underwent sternotomy or thoracotomy.
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Affiliation(s)
- Renad N Balubaid
- College of Medicine, King Saud Bin Abdulaziz University For Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Raghd S Aljedani
- College of Medicine, King Saud Bin Abdulaziz University For Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdulaziz Moglan
- College of Medicine, King Saud Bin Abdulaziz University For Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Yasser B Hennawi
- Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed Hafez Mousa
- College of Medicine and Surgery, Batterjee Medical College, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Majed Alosaimi
- College of Medicine, King Saud Bin Abdulaziz University For Health Sciences, Jeddah, Saudi Arabia.
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
- Department of Orthopedic, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
- King Khalid National Guard Hospital, King Abdulaziz Medical City, National Guard, Jeddah, Saudi Arabia.
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Hattori K, Kawashima H, Ishimaru T, Yanagida Y, Miyake K, Iguchi M, Oiki H, Maeda S, Ihara Y. Musculoskeletal deformities after thoracoscopic versus conventional open repair for esophageal atresia. Asian J Surg 2024; 47:968-972. [PMID: 38030485 DOI: 10.1016/j.asjsur.2023.11.043] [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: 04/27/2023] [Revised: 08/10/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The superiority of thoracoscopic repair (TR) over conventional open repair (COR) for esophageal atresia, especially in terms of long-term outcomes, remains to be investigated. The aim of this study was to compare short- and long-term results between TR and COR group. METHODS Patients who underwent TR or COR for esophageal atresia without other predispositions to musculoskeletal deformities (2003-2016) and had been followed up for a minimum of 5 years were retrospectively reviewed. Musculoskeletal deformities (e.g., scoliosis, chest wall asymmetry, and rib deformities) were mainly evaluated based on the most recent chest radiographs. RESULTS Nine and eight patients were included in the TR and COR groups, respectively; the mean follow-up period was 8.7 and 11.5 years, respectively (p = 0.14). These groups had similar epidemiological characteristics and rates of postoperative complications. Musculoskeletal deformities developed significantly less frequently in the TR group versus the COR group (11 % vs. 88 %, p < 0.05; scoliosis: 0 % vs. 38 %, p = 0.08; chest wall asymmetry: 11 % vs. 50 %, p = 0.14; and rib deformities: 11 % vs. 88 %, p < 0.05, respectively). CONCLUSION TR was associated with a decreased incidence of musculoskeletal deformities and comparable complication rates versus COR for esophageal atresia repair. TR may achieve better long-term outcomes in this setting.
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Affiliation(s)
- Kengo Hattori
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan; Department of Pediatric Surgery, Takatsuki General Hospital, Japan.
| | - Hiroshi Kawashima
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Tetsuya Ishimaru
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshitsugu Yanagida
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kazue Miyake
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Masashi Iguchi
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hironobu Oiki
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Syohei Maeda
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshiyuki Ihara
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
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Bourg A, Gottrand F, Parmentier B, Thomas J, Lehn A, Piolat C, Bonnard A, Sfeir R, Lienard J, Rousseau V, Pouzac M, Liard A, Buisson P, Haffreingue A, David L, Branchereau S, Carcauzon V, Kalfa N, Leclair MD, Lardy H, Irtan S, Varlet F, Gelas T, Potop D, Auger-Hunault M. Outcome of long gap esophageal atresia at 6 years: A prospective case control cohort study. J Pediatr Surg 2023; 58:747-755. [PMID: 35970676 DOI: 10.1016/j.jpedsurg.2022.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/07/2022] [Accepted: 07/26/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND DATA EA is the most frequent congenital esophageal malformation. Long gap EA remains a therapeutic challenge for pediatric surgeons. A case case-control prospective study from a multi-institutional national French data base was performed to assess the outcome, at age of 1 and 6 years, of long gap esophageal atresia (EA) compared with non-long gap EA/tracheo-esophageal fistula (TEF). The secondary aim was to assess whether initial treatment (delayed primary anastomosis of native esophagus vs. esophageal replacement) influenced mortality and morbidity at ages 1 and 6 years. METHODS A multicentric population-based prospective study was performed and included all patients who underwent EA surgery in France from January 1, 2008 to December 31, 2010. A comparative study was performed with non-long gap EA/TEF patients. Morbidity at birth, 1 year, and 6 years was assessed. RESULTS Thirty-one patients with long gap EA were compared with 62 non-long gap EA/TEF patients. At age 1 year, the long gap EA group had longer parenteral nutrition support and longer hospital stay and were significantly more likely to have complications both early post-operatively and before age 1 year compared with the non-long gap EA/TEF group. At 6 years, digestive complications were more frequent in long gap compared to non-long gap EA/TEF patients. Tracheomalacia was the only respiratory complication that differed between the groups. Spine deformation was less frequent in the long gap group. There were no differences between conservative and replacement groups at ages 1 and 6 years except feeding difficulties that were more common in the native esophagus group. CONCLUSIONS Long gap strongly influenced digestive morbidity at age 6 years.
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Affiliation(s)
- Agate Bourg
- Pediatric Surgery Unit, University Hospital Center of Poitiers, 86000 Poitiers, France.
| | - Frédéric Gottrand
- Univ. Lille, CHU Lille, Reference center for rare esophageal diseases, Inserm U1286, F59000, Lille, France
| | - Benoit Parmentier
- Pediatric Surgery Unit, University Hospital Center of Poitiers, 86000 Poitiers, France
| | - Julie Thomas
- Pediatric Surgery Unit, University Hospital Center of Poitiers, 86000 Poitiers, France
| | - Anne Lehn
- Pediatric Surgery Unit, University Hospital of Strasbourg, 67200 Strasbourg, France
| | - Christian Piolat
- Pediatric Surgery Unit, University Hospital of Grenoble, 38700 Grenoble, France
| | - Arnaud Bonnard
- Pediatric Surgery Unit, Robert Debré Hospital APHP, 75019 Paris, France
| | - Rony Sfeir
- Pediatric Surgery Unit, University Hospital of Lille Jeanne de Flandre, 59000 Lille, France
| | - Julie Lienard
- Pediatric Surgery Unit, University Hospital of Nancy, 54035 Nancy, France
| | | | - Myriam Pouzac
- Pediatric Surgery Unit, Hospital of Orléans, 45100 Orléans, France
| | - Agnès Liard
- Pediatric Surgery Unit, University Hospital of Rouen, 76000 Rouen, France
| | - Philippe Buisson
- Pediatric Surgery Unit, University Hospital of Amiens-Picardie, 80054 Amiens, France
| | - Aurore Haffreingue
- Pediatric Surgery Unit, University Hospital of Caen Normandie, 14000 Caen, France
| | - Louis David
- Pediatric Surgery Unit, University Hospital of Dijon F.Mitterand, 21000 Dijon, France
| | - Sophie Branchereau
- Pediatric Surgery Unit, Bicetre Hospital APHP, 94270 Le Kremlin-Bicêtre, France
| | | | - Nicolas Kalfa
- Pediatric Surgery Unit, University Hospital of Montpellier, 34295 Montpellier, France
| | - Marc-David Leclair
- Pediatric Surgery Unit, University Hospital of Nantes Hotel Dieu, 44093 Nantes, France
| | - Hubert Lardy
- Pediatric Surgery Unit, University Hospital of Tours, 37000 Tours, France
| | - Sabine Irtan
- Pediatric Surgery Unit, Armand Trousseau Hospital APHP, 75012 Paris, France
| | - François Varlet
- Pediatric Surgery Unit, University Hospital of Saint-Etienne, 42055 Saint-Etienne Cedex 2
| | - Thomas Gelas
- Pediatric Surgery Unit, University Hospital of Lyon HCL Women Mother Children Hospital, 69500 Bron, France
| | - Diana Potop
- Pediatric Surgery Unit, University Hospital Center of Poitiers, 86000 Poitiers, France
| | - Marie Auger-Hunault
- Pediatric Surgery Unit, University Hospital Center of Poitiers, 86000 Poitiers, France
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Systematic review of long term follow-up and transitional care in adolescents and adults with esophageal atresia - why is transitional care mandatory? Eur J Pediatr 2023; 182:2057-2066. [PMID: 36905437 PMCID: PMC10175361 DOI: 10.1007/s00431-023-04893-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE to review recent literature concerning long-term health issues and transitional care in esophageal atresia (EA) patients. PubMed, Scopus, Embase and Web of Science databases were screened for studies regarding EA patients aged more than or equal to 11 years, published between August 2014 and June 2022. Sixteen studies involving 830 patients were analyzed. Mean age was 27.4 years (range 11-63). EA subtype distribution was: type C (48.8%), A (9.5%), D (1.9%), E (0.5%) and B (0.2%). 55% underwent primary repair, 34.3% delayed repair, 10.5% esophageal substitution. Mean follow-up was 27.2 years (range 11-63). Long-term sequelae were: gastro-esophageal reflux (41.4%), dysphagia (27.6%), esophagitis (12.4%), Barrett esophagus (8.1%), anastomotic stricture (4.8%); persistent cough (8.7%), recurrent infections (4.3%) and chronic respiratory diseases (5.5%). Musculo-skeletal deformities were present in 36 out of 74 reported cases. Reduced weight and height were detected in 13.3% and 6% cases, respectively. Impaired quality of life was reported in 9% of patients; 9.6% had diagnosis or raised risk of mental disorders. 10.3% of adult patients had no care provider. Meta-analysis was conducted on 816 patients. Estimated prevalences are: GERD 42.4%, dysphagia 57.8%, Barrett esophagus 12.4%, respiratory diseases 33.3%, neurological sequelae 11.7%, underweight 19.6%. Heterogeneity was substantial (> 50%). Conclusion: EA patients must continue follow-up beyond childhood, with a defined transitional-care path by a highly specialized multidisciplinary team due to the multiple long-term sequelae. WHAT IS KNOWN • Survival rates of esophageal atresia patients is now more than 90% thanks to the improvements in surgical techniques and intensive care, therefore patients' needs throughout adolescence and adulthood must be taken into account. WHAT IS NEW • This review, by summarizing recent literature concerning long term sequelae of esophageal atresia, may contribute to raise awareness on the importance of defining standardized protocols of transitional and adulthood care for esophageal atresia patients.
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New insights in the prevalence of scoliosis and musculoskeletal asymmetries in adolescents with esophageal atresia. J Pediatr Surg 2023; 58:412-419. [PMID: 36384939 DOI: 10.1016/j.jpedsurg.2022.10.002] [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: 03/16/2022] [Revised: 09/16/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Increased risk of scoliosis and musculoskeletal abnormalities in adolescents with esophageal atresia (EA) is reported, but the impact of these abnormalities on physical fitness and motor skills are not known. METHODS Scoliosis was assessed radiographically and shoulder and chest abnormalities by a standardized protocol. Physical fitness was evaluated with Grippit, Six-minute walk test, and International Physical Activity Questionnaire and motor skills by Motor Assessment Battery for Children. RESULTS Sixty-seven EA adolescents median 16 (13-20) years participated. The prevalence of significant scoliosis (≥ 20º) was 12% (8/67) whereas 22% (15/67) had mild scoliosis (10-19º). Vertebral anomalies occurred in 18/67 (27%), eight of them (44%) had scoliosis. The majority of adolescents (15/23) with scoliosis did not have vertebral anomalies. Musculoskeletal abnormalities were detected in 22-78%. Balance problems occurred three times more frequently than expected (44% vs. 15%, p = 0.004). Submaximal exercise capacity was significantly reduced compared to reference values (p < 0.001). Scoliosis ≥ 20º was related to reduced physical activity (p = 0.008), and musculoskeletal abnormalities to reduced physical activity and impaired motor skills (p = 0.042 and p < 0.038, respectively). CONCLUSIONS Significant scoliosis was diagnosed in 12% of the EA adolescents and related to reduced physical activity. Musculoskeletal abnormalities identified in more than half of the patients, were related to reduced physical activity and impaired motor skills, and exercise capacity was significantly below reference group. EA patients with and without vertebral anomalies need health-promoting guidance to prevent impaired motor skills and consequences of reduced physical activity. LEVEL OF EVIDENCE Prognostic Study, Level II.
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Thoracogenic scoliosis: coronal deformity progression in paediatric patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:639-650. [PMID: 36596912 DOI: 10.1007/s00586-022-07498-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To assess the risk of developing thoracogenic scoliosis (THS) in paediatric patients, depending on the side of lateral thoracotomy (LT) and of spine deviation in the coronal plane by means of logistic regression and scoliosis-free survival analyses. METHODS A total of 307 consecutive patients undergoing LT were retrospectively reviewed; 32 patients met the inclusion criteria: 1) underwent LT and developed THS; 2) age < 15 years at LT; 3) clinical and radiographic follow-up ≥ 5 years. Patients were divided into ipsilateral group (convexity ipsilateral to LT) and contralateral group (convexity contralateral to LT). RESULTS The mean follow-up was 10 ± 4.7 in the ipsilateral group (n = 13) and 12 ± 4.8 years in the contralateral group (n = 19). The contralateral group underwent LT at a younger age (4.4 vs 6.4 years, p = 0.55), developed more severe coronal deformity (27.8° vs 18.9°, p = 0.15), had higher rate of THS > 20° (47.5% vs 38.4%; p = 0.34) and > 45° (21.1% vs 0%; p = 0.99). The mean time from LT to THS diagnosis was 4.2 ± 2.9 in ipsilateral group and 5.5 ± 4.2 years in contralateral group. Left-side LT (p = 0.03) and age > 5 years (p = 0.01) showed a lower risk of THS diagnosis. The group variable had a statistically significant effect on the risk of developing THS > 45° (p = 0.03). CONCLUSION In this series, children that developed THS with a convexity contralateral to the side of LT had more severe and progressive coronal spine deformity. LEVEL OF EVIDENCE III.
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Walk RM. Esophageal Atresia and Tracheoesophageal Fistula. Surg Clin North Am 2022; 102:759-778. [DOI: 10.1016/j.suc.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sacco R, Bonnevalle M, Nectoux E, Fron D, Ould-Slimane M, Sharma D, Lucchesi G, Canavese F. Thoracogenic scoliosis: a retrospective review of 129 pediatric patients with a mean follow-up of 10 years. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2287-2294. [PMID: 35593932 DOI: 10.1007/s00586-022-07242-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/05/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the midterm outcome of lateral thoracotomy (LT) in skeletally immature patients concerning thoracogenic scoliosis development and lung parenchyma resection (LPR) extent. METHODS In total, 129 children met the inclusion criteria: (1) LT during the study period; (2) skeletally immature at the time of LT; (3) clinical and radiographic follow-up of at least 3 years; and (4) no spinal or thoracic deformity on radiographs before LT. Patients were grouped according to their underlying disease, age at LT, and LPR extent. Radiographic parameters were assessed. Kaplan-Meier survival curves and univariate and multivariate analysis were performed. RESULTS Of 129, 108 patients underwent pneumonectomy (9; 9.1%), lobectomy (79; 61.2%), segmentectomy (20; 15.5%) and 21 patients LT without LPR. The mean age at LT and at last radiological follow-up was 5.5 years (birth-17.8) and 15.2 years (3.4-33.2). The mean follow-up was 10 years (3-28.1). Scoliosis developed on average 5.3 years after LT. The mean Cobb angle was 22.1° (11-90°); > 10° in 37/129 patients (28.7%), of whom 5/129 (3.9%) had > 45°. The average vertebral rotation was 16.2° (2-43°; grade 0-II). RVAD was 26.5° (8°-33°) and 15.3° (2-43°) in patients with Cobb > 45° and ≤ 45°. Gender, age at surgery, and extent of LPR were not risk factors for post-thoracotomy scoliosis (p > 0.05), although younger patients developed a more severe deformity. CONCLUSION Although post-thoracotomy scoliosis is not associated with significant rotation, the risk of curve progression > 45° is relatively high. Regular follow-up is required as scoliosis may develop several years after LT with or without LPR.
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Affiliation(s)
- Riccardo Sacco
- Department of Pediatric Orthopaedic Surgery, CHU de Lille, Jeanne de Flandre Hospital, Rue Eugène Avinée, 59000, Lille, France
| | - Michel Bonnevalle
- Department of Pediatric Surgery, CHU de Lille, Jeanne de Flandre Hospital, Rue Eugène Avinée, 59000, Lille, France
| | - Eric Nectoux
- Department of Pediatric Orthopaedic Surgery, CHU de Lille, Jeanne de Flandre Hospital, Rue Eugène Avinée, 59000, Lille, France
| | - Damien Fron
- Department of Pediatric Orthopaedic Surgery, CHU de Lille, Jeanne de Flandre Hospital, Rue Eugène Avinée, 59000, Lille, France
| | | | - Dyuti Sharma
- Department of Pediatric Surgery, CHU de Lille, Jeanne de Flandre Hospital, Rue Eugène Avinée, 59000, Lille, France
| | - Giovanni Lucchesi
- Department of Surgery and Translational Medicine, Orthopaedic Clinic, University of Florence, Florence, Italy
| | - Federico Canavese
- Department of Pediatric Orthopaedic Surgery, CHU de Lille, Jeanne de Flandre Hospital, Rue Eugène Avinée, 59000, Lille, France.
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Musculoskeletal deformities in children with congenital thoracic malformations: a population-based cohort study. Pediatr Surg Int 2022; 38:731-736. [PMID: 35235016 DOI: 10.1007/s00383-022-05101-6] [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] [Accepted: 02/02/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE It is unclear if musculoskeletal deformities observed in patients with congenital diaphragmatic hernia (CDH), congenital lung lesion (CLL) and esophageal atresia/tracheoesophageal fistula (EA/TEF) are associated with the anomaly or are a result of the surgery required to treat the anomaly. This study compared the prevalence of musculoskeletal deformities for: (1) children with congenital thoracic anomalies to controls; (2) CLL to EA/TEF both repaired via thoracotomy; and (3) CLL and EA/TEF to CDH repaired via laparotomy. METHODS We performed a retrospective study of children with CLL, CDH or EA/TEF between 1990 and 2016. Date-of-birth-matched control groups were generated from a population-based dataset. International Classification of Disease codes were used to identify scoliosis and pectus anomalies. We determined Hazard ratios (HR) for cases versus controls. RESULTS We included 167 cases (CDH n = 82; CLL n = 29; EA/TEF n = 56) and 1670 controls. EA/TEF had a greater risk of scoliosis (HR 5.52, 95%CI 1.49,13.73) and pectus deformities (HR 4.07, 95%CI 1.96,8.45). CDH showed more scoliosis (HR 5.03, 95%CI 1.99,12.74) but not pectus anomalies. Musculoskeletal deformities were not more common in CLL. CONCLUSION Children born with CDH or EA/TEF, but not CLL, had more musculoskeletal deformities than controls. The inconsistent association between musculoskeletal deformities and the surgical approach suggested a congenital predisposition.
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Sterlin A, Evans L, Mahler S, Lindner A, Dickmann J, Heimann A, Sahlabadi M, Aribindi V, Harrison MR, Muensterer OJ. An experimental study on long term outcomes after magnetic esophageal compression anastomosis in piglets. J Pediatr Surg 2022; 57:34-40. [PMID: 34656308 DOI: 10.1016/j.jpedsurg.2021.09.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/08/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND/PURPOSE Previous studies have shown that a patent, watertight esophageal anastomosis can be accomplished safely using specially-shaped magnets in piglets. However, it is unclear whether such a magnetic esophageal compression anastomosis (MECA) remains patent in the long-term. The purpose of this study was to evaluate the long-term outcome of MECA in an experimental pig model over an observation period of 2 months. METHODS Ten piglets underwent creation of an MECA with custom-made 8 mm magnets and a U-shaped esophageal bypass loop to allow peroral nutrition at eight weeks of life. Two weeks later, the bypass loop was closed surgically, requiring the pigs to swallow via the newly created magnetic compression anastomosis. The pigs were fed soft chow for 2 months. They were monitored for weight gain and signs of dysphagia. At the endpoint of two months, esophagoscopy and contrast esophagography was performed. After removal of the esophagus, the tissues were macroscopiocally and histologically assessed. RESULTS Six piglets survived until the endpoint. In two pigs, closure of the bypass loop failed, these demonstrated mean weight gain of 792 gs/day [95% Confidence interval 575 to 1009 gs/day]. Weight gain in four pigs that exclusively fed via the magnetic anastomosis averaged 577 gs/day [95% confidence interval 434 to 719 gs/day (p = 0.18)]. There were no signs of dysphagia. All magnets passed with the stool within 16 days. After 2 months, a well-formed magnetic compression anastomosis was visible and easily negotiated with a 6.5 mm endoscope. Esophogram and macroscopic findings confirmed patentency of the esophageal anastomoses. Histopathology showed a circular anastomosis lined with contiguous epithelium. CONCLUSION MECA creates a long-term functional and patent anastomosis in pigs. This concept may facilitate minimally-invasive esophageal atresia repair by obviating a technically challenging and time-consuming hand-sewn anastomosis.
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Affiliation(s)
- Alexander Sterlin
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lauren Evans
- Department of Pediatric Surgery, University of California at San Francisco, San Francisco, California, United States
| | - Sara Mahler
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Andreas Lindner
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jana Dickmann
- Department of Veterinary Medicine, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Axel Heimann
- Department of Veterinary Medicine, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mohammad Sahlabadi
- Department of Pediatric Surgery, University of California at San Francisco, San Francisco, California, United States
| | - Vamsi Aribindi
- Department of Pediatric Surgery, University of California at San Francisco, San Francisco, California, United States
| | - Michael R Harrison
- Department of Pediatric Surgery, University of California at San Francisco, San Francisco, California, United States; Magnamosis, Inc., San Francisco, California, United States
| | - Oliver J Muensterer
- Department of Pediatric Surgery, Johannes Gutenberg University Mainz, Mainz, Germany; Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstrasse 4, Munich 80337, Germany.
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Association of operative approach with outcomes in neonates with esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2021; 56:2172-2179. [PMID: 33994203 DOI: 10.1016/j.jpedsurg.2021.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/17/2021] [Accepted: 04/05/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE We sought to evaluate the impact of thoracoscopic repair on perioperative outcomes in infants with esophageal atresia and tracheoesophageal fistula (EA/TEF). METHODS The American College of Surgeons National Surgical Quality Improvement Program pediatric database from 2014 to 2018 was queried for all neonates who underwent operative repair of EA/TEF. Operative approach based on intention to treat was correlated with perioperative outcomes, including 30-day postoperative adverse events, in logistic regression models. RESULTS Among 855 neonates, initial thoracoscopic repair was performed in 133 (15.6%) cases. Seventy (53%) of these cases were converted to open. Those who underwent thoracoscopic repair were more likely to be full-term (p = 0.03) when compared to those in the open repair group. There were no significant differences in perioperative outcome measures based on surgical approach except for operative time (thoracoscopic: 217 min vs. open: 180 min, p<0.001). A major cardiac comorbidity (OR 1.6, 95% CI 1.2-2.1; p = 0.003) and preoperative ventilator requirement (OR 1.4, 95% CI 1.0-1.9; p = 0.034) were the only risk factors associated with adverse events. CONCLUSIONS Thoracoscopic neonatal repair of EA/TEF continues to be used sparingly, is associated with high conversion rates, and has similar perioperative outcomes when compared to open repair. LEVEL OF EVIDENCE III.
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