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Patkowski D, Toczewski K, Ergun E. Novel Left-Sided Thoracoscopic Approach to Recurrent Tracheoesophageal Fistula and Post-Fistula Tracheal Diverticula. J Clin Med 2023; 12:7251. [PMID: 38068303 PMCID: PMC10707001 DOI: 10.3390/jcm12237251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/31/2023] [Accepted: 11/14/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Recurrent tracheoesophageal fistula (RTEF) is usually a consequence of leakage or other complications after esophageal atresia repair performed through right-sided access. This results in extensive intrapleural adhesions, and open redo surgery poses a challenge. Alternatively, endoscopic endotracheal fistula obliteration usually requires repetitive procedures, and its success rate varies significantly between centers. We present a novel approach to recurrent fistulas. The innovation is in reaching the fistula through the virgin field via left-sided three-port thoracoscopy instead of classical right-sided thoracotomy. METHODS This is a presentation of a new operative technique based on a retrospective case series of patients operated on at our department between 2016 and 2023. RESULTS Eight patients after esophageal atresia repair (six with RTEF and two with post-fistula tracheal diverticula) were successfully treated with left-sided thoracoscopy. There were no conversions. One patient required rethoracoscopy for chylothorax. Another one, after RTEF closure, underwent multiple endoscopic obliterations of subsequent tracheal diverticulum. No other major complications nor re-recurrences were noted. CONCLUSIONS Left-sided thoracoscopy in redo esophageal atresia has the advantage of a "virgin" operative field and grants feasible access to the RTEF or tracheal diverticulum. We believe that this approach is worth further exploration because it combines minimal invasiveness with high effectiveness without all the consequences of a thoracotomy.
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Affiliation(s)
- Dariusz Patkowski
- Clinical Department of Pediatric Surgery and Urology, Wrocław Medical University, Borowska 213, 50-556 Wrocław, Poland;
| | - Krystian Toczewski
- Clinical Department of Pediatric Surgery and Urology, Wrocław Medical University, Borowska 213, 50-556 Wrocław, Poland;
| | - Ergun Ergun
- Department of Pediatric Surgery, Faculty of Medicine, Ankara University, AÜ Tıp Fakültesi Hst. No: 6, Ankara 06620, Turkey
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Țarcă E, Al Namat D, Luca AC, Lupu VV, Al Namat R, Lupu A, Bălănescu L, Bernic J, Butnariu LI, Moscalu M, Hînganu MV. Omphalocele and Cardiac Abnormalities-The Importance of the Association. Diagnostics (Basel) 2023; 13:diagnostics13081413. [PMID: 37189514 DOI: 10.3390/diagnostics13081413] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/25/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
Omphalocele is the most common ventral abdominal wall defect. Omphalocele is associated with other significant anomalies in up to 80% of cases, among which the cardiac ones are the most frequent. The aim of our paper is to highlight, through a review of the literature, the importance and frequency of association between the two malformations and what impact this association has on the management and evolution of patients with these pathologies. We reviewed the titles, the available abstracts, and the full texts of 244 papers from the last 23 years, from three medical databases, to extract data for our review. Due to the frequent association of the two malformations and the unfavorable effect of the major cardiac anomaly on the prognosis of the newborn, the electrocardiogram and echocardiography must be included in the first postnatal investigations. The timing of surgery for abdominal wall defect closure is mostly dictated by the cardiac defect severity, and usually the cardiac defect takes priority. After the cardiac defect is medically stabilized or surgically repaired, the omphalocele reduction and closure of the abdominal defect are performed in a more controlled setting, with improved outcomes. Compared to omphalocele patients without cardiac defects, children with this association are more likely to experience prolonged hospitalizations, neurologic, and cognitive impairments. Major cardiac abnormalities such as structural defects that require surgical treatment or result in developmental delay will significantly increase the death rate of patients with omphalocele. In conclusion, the prenatal diagnosis of omphalocele and early detection of other associated structural or chromosomal anomalies are of overwhelming importance, contributing to the establishment of antenatal and postnatal prognosis.
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Affiliation(s)
- Elena Țarcă
- Department of Surgery II-Pediatric Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Dina Al Namat
- "Saint Mary" Emergency Children Hospital, 700309 Iassy, Romania
| | - Alina Costina Luca
- Department of Mother and Child Medicine-Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Vasile Valeriu Lupu
- Department of Mother and Child Medicine-Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Razan Al Namat
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Ancuța Lupu
- Department of Mother and Child Medicine-Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Laura Bălănescu
- Department of Pediatric Surgery and Anaesthesia and Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Jana Bernic
- Discipline of Pediatric Surgery, "Nicolae Testemițanu" State University of Medicine and Pharmacy, 2025 Chisinau, Moldova
| | - Lăcrămioara Ionela Butnariu
- Department of Medical Genetics, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Marius Valeriu Hînganu
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
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Seleim HM, Wishahy AMK, Magdy B, Elseoudi M, Zakaria RH, Kaddah SN, Elbarbary MM. The dilemma after an unforeseen aortic arch anomalies at thoracoscopic repair of esophageal atresia: Is curtailing surgery still a necessity? Scand J Surg 2022; 111:14574969221090487. [PMID: 35422157 DOI: 10.1177/14574969221090487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE There are several forms of relevant epi-aortic branching anomalies, and perhaps that is why different views as to the best approach have been reported. To help resolve this dilemma, we examined the unforeseen arch anomalies found at thoracoscopic repair of esophageal atresia and the outcomes. METHODS In a retrospective cohort, all consecutive patients who were thoracoscopically approached for esophageal atresia over a 5-year period with unforeseen aortic/epi-aortic branching were identified and grouped. Thoracoscopic views, operative interventions, and outcomes were studied. RESULTS A total of 121 neonates were thoracoscopically approached for EA, of whom 18 cases with aberrant aortic architecture were selected. Four (3%) cases were diagnosed on a preoperative echocardiography as a right-sided aortic arch, whereas unforeseen anomalous anatomies were reported in 14 cases (11.6%): left aortic arch with an aberrant right subclavian artery (ARSA) (n = 10), right-sided aortic arch with an aberrant left subclavian artery (ALSA) (n = 3), and mirror-image right arch (n = 1). Single postoperative mortality was reported among the group with left arch and ARSA (10%), whereas all the cases with right arch and ALSA died. CONCLUSIONS In all, 11.6% of the studied series exhibited unexpected aberrant aortic architecture, with higher complication rates in comparison to the typical thoracoscopic repairs. For EA with left aortic arch and ARSA, the primary esophageal surgery could safely be completed. Meanwhile, curtailing surgery-after ligating the TEF-to get advanced imaging is still advised for both groups with the right arch due to the significant existence of vascular rings.
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Affiliation(s)
- Hamed M Seleim
- Assistant Professor Pediatric Surgery Tanta University Hospitals Tanta 31527 Egypt
| | - Ahmed M K Wishahy
- Pediatric Surgery Department, Cairo University Pediatric Hospital, Cairo, Egypt
| | - Basma Magdy
- Pediatric Surgery Department, Cairo University Pediatric Hospital, Cairo, Egypt
| | - Mohamed Elseoudi
- Pediatric Surgery Department, Cairo University Pediatric Hospital, Cairo, Egypt
| | - Rania H Zakaria
- Radiology Department, Cairo University Hospitals, Cairo, Egypt
| | - Sherif N Kaddah
- Pediatric Surgery Department, Cairo University Pediatric Hospital, Cairo, Egypt
| | - Mohamed M Elbarbary
- Pediatric Surgery Department, Cairo University Pediatric Hospital, Cairo, Egypt
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Tanimoto T, Noda T, Nouso H, Miyata Y. A case of esophageal atresia complicated by a right-sided aortic arch with right ductus arteriosus and inferior vena cava interruption with hemiazygos continuation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2021.102167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Jo Svetanoff W, Zendejas B, Ngo P, Manfredi M, Hamilton TE, Jennings RW, Smithers CJ. The left-sided repair: An alternative approach for difficult esophageal atresia repair. J Pediatr Surg 2021; 56:938-943. [PMID: 33248682 DOI: 10.1016/j.jpedsurg.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE We describe a left-sided approach for long gap esophageal atresia (LGEA) repair in patients who have a large leftward upper pouch and no significant tracheomalacia, or as a salvage strategy after prior failed right-sided repairs. METHODS Retrospective review of patients who underwent repair via traction induced growth (Foker procedure [FP]) from 2014 to 2019 was performed. Surgical technique and post-operative outcomes were evaluated. RESULTS Of 47 LGEA patients, 18 (38%) were approached via the left side - 94% had a left aortic arch, and 22% had prior attempts at a right-sided anastomosis. More left-sided patients underwent minimally invasive repair (39% vs 7%, p = 0.007) and internal traction (50% vs 10%, p = 0.002) compared to right-sided patients. On multivariate analysis, internal traction was associated with a decreased length of paralysis (p<0.01); length of intubation and hospital stay were similar between groups. Anastomotic leak (17% vs 20%, p = 0.80) and stricture resection (6% vs 24%, p = 0.12) rates were similar. No left-sided FP patient required additional surgery for tracheomalacia, while six right-sided patients required intervention. CONCLUSION Left-sided FP can be considered for LGEA patients with a large leftward upper pouch or as a salvage pathway after a failed right chest approach, with similar outcomes to the right-sided approach.
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Affiliation(s)
- Wendy Jo Svetanoff
- Department of General Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States; Department of Pediatric Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, United States
| | - Benjamin Zendejas
- Department of General Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States
| | - Peter Ngo
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States
| | - Michael Manfredi
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States
| | - Thomas E Hamilton
- Department of General Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States
| | - Russell W Jennings
- Department of General Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States
| | - C Jason Smithers
- Department of General Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States; Department of Surgery, Johns Hopkins All Children's Hospital, 601 5th St S, Ste306, St. Petersburg, FL 33701, United States.
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Tanny SPT, King SK, Comella A, Hawley A, Brooks JA, Hunt RW, Jones B, Teague WJ. Selective approach to preoperative echocardiography in esophageal atresia. Pediatr Surg Int 2021; 37:503-509. [PMID: 33388963 DOI: 10.1007/s00383-020-04795-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Preoperative echocardiography is used routinely in neonates with esophageal atresia to identify patients in whom congenital cardiac disease will impact upon anesthetic and surgical decision-making. We aimed to determine the suitability of selective preoperative echocardiography. METHODS We performed a single-center retrospective review of neonates with esophageal atresia over 6 years (2010-2015) at our tertiary pediatric institution. Data included preoperative clinical examination, chest x-ray, and echocardiography. Endpoints were cardiovascular, respiratory, radiological, and echocardiography findings. Selective strategies were assessed using sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS We identified 115 neonates with esophageal atresia. All underwent preoperative echocardiography. Cardiac defects were identified in 49/115 (43%) (major 9/115, moderate 4/115). Sensitivity, specificity, positive predictive value, and negative predictive value of abnormal clinical and radiologic assessment for major and moderate cardiac defects were 92%, 25%, 13%, 96%; for clinical examination alone were 92%, 25%, 14%, 96%; for absence of murmur, cyanosis, and abnormal respiratory examination were 92%, 28%, 13%, 97%. Selective strategies reduce echocardiograms performed by 22%. CONCLUSION Selective strategies allow for identification of neonates with esophageal atresia who may have deferral of echocardiogram unill after surgery. Selection may improve timeliness of care and resource utilization, without compromising patient safety.
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Affiliation(s)
- Sharman P Tan Tanny
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Sebastian K King
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Assia Comella
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia.,F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Alisa Hawley
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia.,F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia
| | - Jo-Anne Brooks
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia.,F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia
| | - Rod W Hunt
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia.,Clinical Sciences, Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Bryn Jones
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Department of Cardiology, The Royal Children's Hospital, Melbourne, Australia
| | - Warwick J Teague
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia. .,Department of Paediatrics, The University of Melbourne, Melbourne, Australia. .,F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia.
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Saka R, Tazuke Y, Ueno T, Nomura M, Deguchi K, Okuyama H. Esophageal atresia with right aortic arch: An experience of thoracoscopic repair through left thorax. Asian J Endosc Surg 2021; 14:301-304. [PMID: 32885582 DOI: 10.1111/ases.12862] [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: 06/24/2020] [Revised: 07/28/2020] [Accepted: 08/18/2020] [Indexed: 11/28/2022]
Abstract
Right aortic arch (RAA) is one of congenital cardiovascular anomalies associated with esophageal atresia (EA). The surgical treatment for EA with RAA is still challenging. Although most pediatric surgeons are familiar with the right-sided approach, the division of the tracheoesophageal fistula and the anastomosis of the esophagus through right thorax are often difficult in cases of RAA. There are a few reports on thoracoscopic repair for EA with RAA. We report a case of EA with RAA treated by left-sided thoracoscopic approach. With left-sided thoracoscopic approach, identification and anastomosis of the esophagus could be safely performed without obstruction by the right-sided descending aorta. There was no leakage or stricture. Thoracoscopic repair of EA with RAA through the left thorax is feasible and safe without obstruction by the right-sided descending aorta.
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Affiliation(s)
- Ryuta Saka
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuko Tazuke
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takehisa Ueno
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Motonari Nomura
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koichi Deguchi
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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