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Wolfe C, Jnah A. Tracheoesophageal Fistula With Esophageal Atresia: A Case Series. Neonatal Netw 2024; 43:65-75. [PMID: 38599775 DOI: 10.1891/nn-2023-0051] [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] [Indexed: 04/12/2024]
Abstract
Tracheoesophageal fistula (TEF) with or without esophageal atresia (EA) results from maldevelopment of the trachea and esophagus during maturation of the primitive foregut. EA/TEF commonly presents shortly after birth because of increased oral secretions and the inability to advance a nasogastric or orogastric tube to the proper depth. Given that prenatal diagnosis is uncommon and early intervention is important to reduce morbidity and mortality risk, early recognition and diagnosis are imperative. We present a case series of two neonates diagnosed with EA/TEF, type "C" and type "E," born at low-acuity centers, who required transport to a tertiary center for surgical support. The pathophysiology as well as types of TEFs, symptomology, stabilization goals, corrective treatment, and long-term implications will be examined. Finally, the educational needs of parents and caregivers will be discussed.
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O'Connor E, Jaffray B. Surgeon-Level Variation in Outcome following Esophageal Atresia Repair Is Not Explained by Volume. Eur J Pediatr Surg 2022; 32:160-169. [PMID: 33368086 DOI: 10.1055/s-0040-1721419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION To assess whether there is a difference in operative outcome for esophageal atresia (EA) depending on a surgeon's seniority as defined by years in consultant practice or number of cases performed. In addition a Clavien-Dindo score was used to sequentially analyze the outcome of each surgeon's EA procedure. MATERIALS AND METHODS All repairs performed over 22 years in an English regional center were analyzed. Outcomes were: death, anastomotic leak, need for dilatation, need for more than three dilatations, need for fundoplication, and a Clavien-Dindo adverse outcome of ≥3b. Possible explanatory variables were: number of prior repairs by the surgeon, surgeon's years of consultant experience. We also examined the effect of variables intrinsic to the infant as possible confounding variables and as independent predictors of outcome. RESULTS A total of 190 repairs were performed or supervised by 12 consultants. There was no significant association between consultant experience and any objective outcome. However, sequential analysis suggests there is variation between surgeons in the incidence of Clavien-Dindo events of ≥3b. Performance showed deterioration in one case. Mortality was explicable by cardiac and renal anomalies. CONCLUSION There are surgeon-level variations in outcomes for the procedure of EA repair, but they are not explained by volume. Surgeon performance can deteriorate. Our study would not support the concept that patient outcomes could be improved by concentrating the provision of this surgery to fewer hospitals or surgeons.
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Affiliation(s)
- Elizabeth O'Connor
- Department of Paediatric Surgery, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Bruce Jaffray
- Department of Paediatric Surgery, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
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Diagnostic Value of Prenatal Ultrasound Parameters and Esophageal Signs in Pouch and Lower Thoracic Segment in Fetuses with Esophageal Atresia. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2021:8107461. [PMID: 34976113 PMCID: PMC8716201 DOI: 10.1155/2021/8107461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022]
Abstract
In order to investigate the diagnostic value of prenatal ultrasound parameters and signs of pouch and lower thoracic esophagus in the fetus with esophageal atresia (EA), the prenatal ultrasound data of 35 EA fetuses (observation group) confirmed by autopsy after induced labor or postnatal surgery and imaging examination in our hospital from May 2019 to May 2021 were retrospectively analyzed and compared with 35 normal postnatal fetuses (control group). General information and prenatal ultrasound parameters of the two groups, including head circumference (HC), abdominal circumference (AC), double parietal diameter (BPD), fetal body weight (EFW), and signs (small or unmanifested gastric vesicles, amniotic fluid, neck or upper chest pouch, lower chest esophagus not visible), were analyzed using logistic regression. The logistic multifactor regression model for EA diagnosis was established, and the diagnostic value for EA was analyzed. As a result, the HC, AC, and EFW of the observation group were lower than those of the control group, the gastric bubbles were small or not displayed, the amniotic fluid was more, and the signs of neck or upper chest pouch and lower chest esophagus were not visible in the observation group (P < 0.05). Logistic regression analysis showed that decreased ultrasound parameters HC, AC, EFW, small or no gastric bubble, amniotic fluid, neck or upper chest pouch, and no visible signs of lower chest esophagus were all risk factors for EA (P < 0.05). And in the prenatal ultrasound diagnostic model of EA was established, logistic (P) = −19.851 + HC × 0.384 + AC × 0.682 + EFW × 0.695 + small or no gastric vesicle × 3.747 + amniotic fluid × 3.607 + cervical or upper chest sac × 4.104 + invisible lower thoracic esophagus × 4.623.When logistic (P) > 0.468, AUC was 0.891, χ2 was 7.764, diagnostic sensitivity was 91.24%, and specificity was 79.22%. To draw a conclusion, prenatal ultrasound parameters and signs are of great value in the diagnosis of EA. Independent influencing factors of EA include small or no HC, AC, EFW and gastric vesicles, polyhydramnios, neck or upper chest pouch, and invisible lower thoracic esophagus. Logistic multifactor regression model has a high coincidence rate for the prenatal diagnosis of EA, providing a basis for clinical decision-making.
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Kennedy AA, Hart CK, de Alarcon A, Putnam PE, von Allmen D, Lehenbauer D, Bryant R, Torres-Silva C, Rutter MJ. Slide Tracheoplasty for Repair of Complex Tracheoesophageal Fistulas. Laryngoscope 2021; 132:1542-1547. [PMID: 34338338 DOI: 10.1002/lary.29785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Repair of large, recurrent, and complex tracheoesophageal fistulas (TEFs) is challenging and numerous different surgical approaches exist. These various techniques each carry a set of risks and possible complications such as fistula recurrence, tracheal stenosis or pouches, esophageal stenosis, and recurrent laryngeal nerve injury. Slide tracheoplasty is a reconstructive technique successfully used in many different airway pathologies, including TEF repair. This study examines the success, limits, and complications related to slide tracheoplasty for repair of complex TEFs. STUDY DESIGN Retrospective chart review. METHODS Patients undergoing TEF repair using a cervical or thoracic approach slide tracheoplasty, at a single institution, between July 2008 and December 2019 were retrospectively reviewed. Demographic data, comorbidities, TEF etiology and surgical history, slide tracheoplasty details and outcomes, and postoperative complication data were examined using descriptive statistics. RESULTS Twenty-six patients underwent 27 slide tracheoplasties for TEF (20 cervical approaches, 7 thoracic approaches) with a mean age of 5.2 years (IQR 0.7-7.6) at time of surgery. The most common TEF etiologies included congenital (n = 13), tracheostomy tube erosion (n = 5), and button battery ingestion (n = 4). Fistulas ranged in size from <0.5 mm to 4 cm and 59% had previous endoscopic or open repairs. There were two TEF recurrences (7.4%), one of which was successfully revised and the other which was treated with stent placement. Postoperative complications included dehiscence (3.7%), unilateral vocal fold paralysis (3.7%), and mild tracheal stenosis (18.5%). CONCLUSIONS Slide tracheoplasty is an effective surgical technique for treating complex congenital and acquired TEFs with lower rates of complications when compared to other techniques. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
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Affiliation(s)
- Aimee A Kennedy
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Catherine K Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.,Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.,Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Philip E Putnam
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Division of Gastroenterology, Nutrition and Hepatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Daniel von Allmen
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - David Lehenbauer
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Roosevelt Bryant
- Department of Thoracic and Cardiovascular Surgery, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A
| | - Cherie Torres-Silva
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.,Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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5
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Apfeld JC, Wood RJ, Halleran DR, Deans KJ, Minneci PC, Cooper JN. Relationships Between Hospital and Surgeon Operative Volumes and Surgical Outcomes in Hirschsprung's Disease. J Surg Res 2021; 257:379-388. [DOI: 10.1016/j.jss.2020.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/14/2020] [Accepted: 08/02/2020] [Indexed: 12/20/2022]
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Campos J, Tan Tanny SP, Kuyruk S, Sekaran P, Hawley A, Brooks JA, Bekhit E, Hutson JM, Crameri J, McLeod E, Teague WJ, King SK. The burden of esophageal dilatations following repair of esophageal atresia. J Pediatr Surg 2020; 55:2329-2334. [PMID: 32143903 DOI: 10.1016/j.jpedsurg.2020.02.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/02/2020] [Accepted: 02/06/2020] [Indexed: 02/07/2023]
Abstract
AIM To describe the burden of esophageal dilatations in patients following esophageal atresia (EA) repair. METHOD A retrospective review was performed at The Royal Children's Hospital, Melbourne, of all neonates undergoing operative repair for EA over a 17-year period (1999-2015). Stricture was defined by radiological and/or intra-operative findings of narrowing at the esophageal anastomosis. Data recorded included EA type, perinatal details, operative approach, esophageal anastomosis outcome, dilatation requirement, and survival. Key endpoints were anastomotic leakage and tension, esophageal dilatation technique, dilatation frequency, fundoplication, and complications. RESULTS During the study period, 287 newborn EA patients were admitted, of which 258 underwent operative repair and survived to primary discharge. Excluding 11 patients with isolated tracheoesophageal fistula, 247 patients were included in the final analysis. Intra-operative anastomotic tension was documented in 41/247 (16.6%), anastomotic leak occurred in 48/247 (19.4%), and fundoplication was performed in 37/247 (15.0%). Dilatations were performed in 149/247 (60.3%). Techniques included bougie-alone (92/149, 61.7%), combination of bougie and balloon (51/149, 34.2%), and balloon-alone (6/149, 4.0%). These patients underwent 1128 dilatations; median number of dilatations per patient was 4 (interquartile range 2-8). Long-gap EA and anastomotic tension were risk factors (p < 0.01) for multiple dilatations. Complications occurred in 13/1128 (1.2%) dilatation episodes: 11/13 esophageal perforation, 2/13 clinically significant aspiration. Perforations were rare events in both balloon (6/287, 2.1%) and bougie dilatations (4/841, 0.5%); one patient had a perforation from guidewire insertion. CONCLUSIONS Esophageal dilatation occurred in a majority of EA patients. Long-gap EA was associated with an increased burden of esophageal dilatation. Perforations were rare events in balloon and bougie dilatations. TYPE OF STUDY Original article - retrospective review. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Jose Campos
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia
| | - Sharman P Tan Tanny
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC 3010, Australia.
| | - Sema Kuyruk
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia
| | - Prabhu Sekaran
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia
| | - Alisa Hawley
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Neonatal Intensive Care, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia
| | - Jo-Anne Brooks
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Neonatal Intensive Care, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia
| | - Elhamy Bekhit
- Department of Medical Imaging, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia
| | - John M Hutson
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Joseph Crameri
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia
| | - Elizabeth McLeod
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia
| | - Warwick J Teague
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Sebastian K King
- Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia; F. Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC 3010, Australia; Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia
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Koumbourlis AC, Belessis Y, Cataletto M, Cutrera R, DeBoer E, Kazachkov M, Laberge S, Popler J, Porcaro F, Kovesi T. Care recommendations for the respiratory complications of esophageal atresia-tracheoesophageal fistula. Pediatr Pulmonol 2020; 55:2713-2729. [PMID: 32716120 DOI: 10.1002/ppul.24982] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/18/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022]
Abstract
Tracheoesophageal fistula (TEF) with esophageal atresia (EA) is a common congenital anomaly that is associated with significant respiratory morbidity throughout life. The objective of this document is to provide a framework for the diagnosis and management of the respiratory complications that are associated with the condition. As there are no randomized controlled studies on the subject, a group of experts used a modification of the Rand Appropriateness Method to describe the various aspects of the condition in terms of their relative importance, and to rate the available diagnostic methods and therapeutic interventions on the basis of their appropriateness and necessity. Specific recommendations were formulated and reported as Level A, B, and C based on whether they were based on "strong", "moderate" or "weak" agreement. The tracheomalacia that exists in the site of the fistula was considered the main abnormality that predisposes to all other respiratory complications due to airway collapse and impaired clearance of secretions. Aspiration due to impaired airway protection reflexes is the main underlying contributing mechanism. Flexible bronchoscopy is the main diagnostic modality, aided by imaging modalities, especially CT scans of the chest. Noninvasive positive airway pressure support, surgical techniques such as tracheopexy and rarely tracheostomy are required for the management of severe tracheomalacia. Regular long-term follow-up by a multidisciplinary team was considered imperative. Specific templates outlining the elements of the clinical respiratory evaluation according to the patients' age were also developed.
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Affiliation(s)
- Anastassios C Koumbourlis
- Division of Pulmonary & Sleep Medicine, Children's National Hospital, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
| | - Yvonne Belessis
- Department of Respiratory Medicine, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Mary Cataletto
- Division of Pediatric Pulmonary Medicine, New York University, Winthrop University Hospital, Mineola, New York
| | - Renato Cutrera
- Academic Department of Pediatrics (DPUO), Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Pediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy
| | - Emily DeBoer
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado Denver, Children's Hospital Colorado Breathing Institute, Aurora, Colorado
| | - Mikhail Kazachkov
- Department of Pediatric Pulmonology, Gastroesophageal, Upper Airway and Respiratory Diseases Center, New York University School of Medicine, New York, New York
| | - Sophie Laberge
- Department of Pediatrics, Division of Respiratory Medicine, Sainte-Justine University Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Jonathan Popler
- Division of Pediatric Pulmonology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Federica Porcaro
- Department of Pediatrics, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Thomas Kovesi
- Pediatrics, Division of Respirology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
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Sømme S, Shahi N, McLeod L, Torok M, McManus B, Ziegler MM. Neonatal surgery in low- vs. high-volume institutions: a KID inpatient database outcomes and cost study after repair of congenital diaphragmatic hernia, esophageal atresia, and gastroschisis. Pediatr Surg Int 2019; 35:1293-1300. [PMID: 31372730 DOI: 10.1007/s00383-019-04525-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND/PURPOSE The volume-outcome relationship and optimal surgical volumes for repair of congenital anomalies in neonates is unknown. METHODS A retrospective study of infants who underwent diaphragmatic hernia (CDH), gastroschisis (GS), and esophageal atresia/tracheoesophageal fistula (EA/TEF) repair at US hospitals using the Kids' Inpatient Database 2009-2012. Distribution of institutional volumes was calculated. Multi-level logistic/linear regressions were used to determine the association between volume and mortality, length of stay, and costs. RESULTS Total surgical volumes were 1186 for CDH, 1280 for EA/TEF, and 3372 for GS. Median case volume per institution was three for CDH and EA/TEF, and four for GS. Hospitals with annual case volumes ≥ 75th percentile were considered high volume. Approximately, half of all surgeries were performed at low-volume hospitals. No clinically meaningful association between volume and outcomes was found for any procedure. Median cost was greater at high- vs. low-volume hospitals [CDH: $165,964 (p < 0.0001) vs. $104,107, EA/TEF: $85,791 vs. $67,487 (p < 0.006), GS: $83,156 vs. $72,710 (p < 0.0009)]. CONCLUSIONS An association between volume and outcome was not identified in this study using robust outcome measures. The cost of care was higher in high-volume institutions compared to low-volume institutions. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Stig Sømme
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, 80045, USA.,Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Niti Shahi
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, 80045, USA. .,Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Lisa McLeod
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - Michelle Torok
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA
| | - Beth McManus
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA
| | - Moritz M Ziegler
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, 80045, USA.,Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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Bussières V, Roy S, Deladoey J, Rousseau É, St-Vil D, Piché N. Pediatric thyroidectomy: Favorable outcomes can be achieved by a multidisciplinary team of pediatric providers. J Pediatr Surg 2019; 54:527-530. [PMID: 30054058 DOI: 10.1016/j.jpedsurg.2018.06.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/05/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
Abstract
AIM OF THE STUDY Recent publications suggest pediatric surgeons may not be well suited to perform thyroid surgeries unless considered high volume. We sought to assess the outcome of thyroidectomies performed by pediatric surgeons in an academic setting. METHODS We reviewed charts of patients younger than 18 years who underwent thyroid surgeries at a free standing children's hospital between April 2006 and October 2015. MAIN RESULTS The analysis included 118 surgeries in 98 patients (mean age 11.8 years). Most surgeries were performed by a single pediatric surgeon (average 10 thyroidectomies per year). The commonest indication for resection was thyroid nodule (64%). 80% of patients had a single surgery; the remainder had two, including 13 completion hemithyroidectomies. Cancer was found in 37% of specimens, with papillary subtype being most common (72%). Seven patients had locoregional metastases and one had pulmonary metastases. Among the 17 malignant cases that had a second intervention, 6 had malignancy in the resected specimen. There were no deaths in the follow up period (mean 2.7 years). Two patients had permanent hypocalcemia, and three had persistent unilateral recurrent laryngeal nerve injuries causing dysphonia for a total permanent complication rate of 4.2%. CONCLUSIONS We conclude that pediatric thyroidectomy is a safe procedure when performed by pediatric surgeons. Our rate of complications is comparable to those reported in the literature. Our data highlight the need for a vigilant and multidisciplinary approach for children with thyroid pathology. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Shreyas Roy
- Faculty of Medicine, University of Montreal, Montreal, Qc, Canada; Department of Surgery, Division of Pediatric Surgery, CHU Sainte-Justine, Montreal, Qc, Canada
| | - Johnny Deladoey
- Department of Pediatrics, Division of Pediatric Endocrinology, CHU Sainte-Justine, Montreal, Qc, Canada
| | - Élisabeth Rousseau
- Faculty of Medicine, University of Montreal, Montreal, Qc, Canada; Department of Pediatrics, CHU Sainte-Justine, Montreal, Qc, Canada
| | - Dickens St-Vil
- Faculty of Medicine, University of Montreal, Montreal, Qc, Canada; Department of Surgery, Division of Pediatric Surgery, CHU Sainte-Justine, Montreal, Qc, Canada
| | - Nelson Piché
- Faculty of Medicine, University of Montreal, Montreal, Qc, Canada; Department of Surgery, Division of Pediatric Surgery, CHU Sainte-Justine, Montreal, Qc, Canada.
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