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Krishnan U, Dumont MW, Slater H, Gold BD, Seguy D, Bouin M, Wijnen R, Dall'Oglio L, Costantini M, Koumbourlis AC, Kovesi TA, Rutter MJ, Soma M, Menzies J, Van Malleghem A, Rommel N, Dellenmark-Blom M, Wallace V, Culnane E, Slater G, Gottrand F, Faure C. The International Network on Oesophageal Atresia (INoEA) consensus guidelines on the transition of patients with oesophageal atresia-tracheoesophageal fistula. Nat Rev Gastroenterol Hepatol 2023; 20:735-755. [PMID: 37286639 DOI: 10.1038/s41575-023-00789-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 06/09/2023]
Abstract
Oesophageal atresia-tracheoesophageal fistula (EA-TEF) is a common congenital digestive disease. Patients with EA-TEF face gastrointestinal, surgical, respiratory, otolaryngological, nutritional, psychological and quality of life issues in childhood, adolescence and adulthood. Although consensus guidelines exist for the management of gastrointestinal, nutritional, surgical and respiratory problems in childhood, a systematic approach to the care of these patients in adolescence, during transition to adulthood and in adulthood is currently lacking. The Transition Working Group of the International Network on Oesophageal Atresia (INoEA) was charged with the task of developing uniform evidence-based guidelines for the management of complications through the transition from adolescence into adulthood. Forty-two questions addressing the diagnosis, treatment and prognosis of gastrointestinal, surgical, respiratory, otolaryngological, nutritional, psychological and quality of life complications that patients with EA-TEF face during adolescence and after the transition to adulthood were formulated. A systematic literature search was performed based on which recommendations were made. All recommendations were discussed and finalized during consensus meetings, and the group members voted on each recommendation. Expert opinion was used when no randomized controlled trials were available to support the recommendation. The list of the 42 statements, all based on expert opinion, was voted on and agreed upon.
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Affiliation(s)
- Usha Krishnan
- Department of Paediatric Gastroenterology, Sydney Children's Hospital, Sydney, New South Wales, Australia.
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Michael W Dumont
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Hayley Slater
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Benjamin D Gold
- Children's Center for Digestive Health Care, GI Care for Kids, LLC, Atlanta, GA, USA
| | - David Seguy
- University of Lille, Reference Centre for Rare Oesophageal Diseases, CHU Lille, Lille, France
- Department of Nutrition, CHU Lille, Lille, France
| | - Mikael Bouin
- University of Montreal, CHUM Research Center (CRCHUM), Montréal, Quebec, Canada
| | - Rene Wijnen
- Department of Paediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Luigi Dall'Oglio
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mario Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Anastassios C Koumbourlis
- Division of Pulmonary & Sleep Medicine, Children's National Medical Center, Washington, DC, USA
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Thomas A Kovesi
- Deptartment of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- The University of Ottawa, Ottawa, Ontario, Canada
| | - Michael J Rutter
- Division of Paediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Otolaryngology, University of Cincinnati, Cincinnati, OH, USA
| | - Marlene Soma
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Otolaryngology, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Jessica Menzies
- Department of Nutrition and Dietetics, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | | | - Nathalie Rommel
- Department of Gastroenterology, Department of Neurogastroenterology and Motility, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, ExpORL, Deglutology, University of Leuven, Leuven, Belgium
| | - Michaela Dellenmark-Blom
- Department of Paediatric Surgery, The Queen Silvia Children's hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Vuokko Wallace
- Department of Psychology, University of Bath, Bath, UK
- Department of Psychology, University of Eastern Finland, Joensuu, Finland
| | - Evelyn Culnane
- Transition Support Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Graham Slater
- EAT Oesophageal Atresia Global Support Groups e.V., Stuttgart, Germany
| | - Frederic Gottrand
- University of Lille, Reference Centre for Rare Oesophageal Diseases, CHU Lille, Lille, France
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Lille, France
- Institute for Translational Research in Inflammation INFINITE, Inserm Faculté de Médecine, Université de Lille, Lille, France
| | - Christophe Faure
- Division of Paediatric Gastroenterology & Oesophagus Development and Engineering Lab, Sainte-Justine Hospital, Montréal, Quebec, Canada
- Université de Montréal, Montréal, Quebec, Canada
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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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Lieber J, Schmidt A, Kumpf M, Fideler F, Schäfer JF, Kirschner HJ, Fuchs J. Functional outcome after laparoscopic assisted gastric transposition including pyloric dilatation in long-gap esophageal atresia. J Pediatr Surg 2020; 55:2335-2341. [PMID: 32646666 DOI: 10.1016/j.jpedsurg.2020.06.004] [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] [Received: 10/07/2019] [Revised: 04/21/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND/PURPOSE Among the options for esophageal replacement in long-gap esophageal atresia (LGEA), gastric transposition (GT) is accessible for an endoscopic approach. Here we report a novel technique and functional results after laparoscopic-assisted gastric transposition (LAGT), including pyloric dilatation in patients with LGEA. METHODS Retrospective analysis of 14 children undergoing LAGT. Surgical steps included the release of the gastrostomy, transumbilical ante-situ section of the stomach including pyloric balloon-dilation, and laparoscopically controlled transhiatal retromediastinal blunt dissection followed by LAGT for cervical anastomosis to the proximal esophagus. RESULTS The median age at LAGT was 110 days (33-327 days), bodyweight 5.3 kg (3.1-8.3 kg). Operation time was 255 min (180-436 min); one conversion was necessary. The duration of ventilation was 4 days (1-14 days). Postpyloric feeding was started after 2 days, and oral feeding after 13 days. Complications were recurrent pleural effusion or pneumothorax and transient Horner syndrome or transient incomplete paresis of the recurrence nerve. After a median follow-up of 60 months (13-240 months), all children have a patent upper GI tract, show weight gain, and are fed without delayed gastric emptying, dumping, or reflux. Severe (n = 1) or mild (n = 2) anastomotic or pyloric (n = 5) stenosis was resolved with endoscopic dilatations. CONCLUSIONS Functional outcome after LAGT in patients with LGEA is good. The laparoscopic retromediastinal dissection preserves thoracal structures and increases patients' safety. The technique of pyloric dilatation might also prevent dumping syndrome. TYPE OF STUDY Case Series with no Comparison Group. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Justus Lieber
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tübingen, Germany.
| | - Andreas Schmidt
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tübingen, Germany
| | - Matthias Kumpf
- Department of Pediatric Cardiology, Pulmonology, and Intensive Care Medicine, University Children's Hospital, Tübingen, Germany
| | - Frank Fideler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Tübingen, Germany
| | - Jürgen F Schäfer
- Department of Diagnostic Radiology, University Hospital, Tübingen, Germany
| | - Hans-Joachim Kirschner
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tübingen, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tübingen, Germany
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Svetanoff WJ, Zendejas B, Smithers CJ, Prabhu SP, Baird CW, Jennings RW, Hamilton TE. Great vessel anomalies and their impact on the surgical treatment of tracheobronchomalacia. J Pediatr Surg 2020; 55:1302-1308. [PMID: 31422856 DOI: 10.1016/j.jpedsurg.2019.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/28/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tracheobronchial compression (TBC) from great vessel anomalies (GVA) can contribute to tracheobronchomalacia (TBM) symptoms. The frequency, impact on symptoms and optimal management of GVA in these patients, with or without a history of esophageal atresia (EA), are still unclear. STUDY DESIGN Patients who underwent surgery for TBM/ TBC between 2001 and 2017 were reviewed. Demographics, type of GVA, and operative interventions were collected. The frequency and treatment modalities of GVA between EA and non-EA patients were compared. RESULTS Overall, 209 patients met criteria; 120 (57.4%) patients had at least one GVA, including double aortic arches (n = 4, 1.9%), right aortic arches (n = 14, 6.7%), aberrant right subclavian arteries (n = 15, 7.2%), and innominate artery compression (n = 71, 34.0%). Non-EA patients were more likely to have surgery later in life (29.5 months versus 16 months, p = 0.0002), double aortic arch (p = 0.0174), right aortic arch (p < 0.0001), and undergo vascular reconstruction concurrently with their airway procedure (25% vs 8.4%, p = 0.002). Vessel reconstruction was performed in 25 patients; six required cardiac bypass. CONCLUSION The frequency of GVA in patients with symptomatic airway collapse is substantial. Multidisciplinary evaluation is imperative for operative planning as many require complex reconstruction and collaboration with cardiac surgery, particularly patients without a history of EA. LEVEL OF EVIDENCE Level III.
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Lejeune S, Le Mee A, Petyt L, Hutt A, Sfeir R, Michaud L, Fayoux P, Deschildre A, Gottrand F, Thumerelle C. Bronchopulmonary and vascular anomalies are frequent in children with oesophageal atresia. Acta Paediatr 2020; 109:1221-1228. [PMID: 31710383 DOI: 10.1111/apa.15086] [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: 06/01/2019] [Revised: 09/23/2019] [Accepted: 11/07/2019] [Indexed: 12/30/2022]
Abstract
AIM Oesophageal atresia is frequently associated with other malformations, and our aim was to use computed tomography (CT) to explore intrathoracic malformations in patients with this condition. METHOD This was retrospective study of children aged 0-16 with oesophageal atresia who were born in 1996-2013 and followed up at the French reference centre for rare oesophageal diseases at the University of Lille. Computed tomography scans were available for 48 of the 234 patients during follow-up visits, and these were reviewed by a thoracic radiologist. RESULTS More than two-thirds of the scans were performed to explore persistent respiratory symptoms. We found that six patients had a pulmonary malformations: four lobar agenesis, one right pulmonary aplasia and one congenital cystic adenomatoid malformation. Computed tomography enabled us to diagnose unexpected thoracic malformations in 16 patients: four lobar agenesis, six arteria lusoria, five persistent left superior vena cava and one partial anomalous pulmonary venous return. It also confirmed the diagnoses of suspected malformations in five patients: one congenital cystic adenomatoid malformation, one pulmonary hypoplasia, two right-sided aortic arches and one communicating bronchopulmonary foregut malformation. CONCLUSION Intrathoracic anomalies were frequently associated with oesophageal atresia, and contrast-enhanced chest CT scans should be performed on patients with persistent respiratory symptoms.
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Affiliation(s)
- Stephanie Lejeune
- Pediatric Pulmonology and Allergy Department Pole Enfant Jeanne de Flandre Hospital CHU Lille Univ. Lille Lille France
- CRACMO: Centre de Réference des Affections Chroniques et Malformatives de l'œsophage Reference Centre for Rare Oeophageal Diseases CHU Lille LIRIC UMR 995 Univ. Lille Lille France
| | - Armelle Le Mee
- Pediatric Pulmonology and Allergy Department Pole Enfant Jeanne de Flandre Hospital CHU Lille Univ. Lille Lille France
| | - Laurent Petyt
- Department of Paediatric Imaging Hospital Jeanne de Flandre Hospital CHU Lille Univ. Lille Lille France
| | - Antoine Hutt
- Department of Thoracic Imaging Hospital Calmette CHU Lille Univ. Lille Lille France
| | - Rony Sfeir
- CRACMO: Centre de Réference des Affections Chroniques et Malformatives de l'œsophage Reference Centre for Rare Oeophageal Diseases CHU Lille LIRIC UMR 995 Univ. Lille Lille France
| | - Laurent Michaud
- CRACMO: Centre de Réference des Affections Chroniques et Malformatives de l'œsophage Reference Centre for Rare Oeophageal Diseases CHU Lille LIRIC UMR 995 Univ. Lille Lille France
| | - Pierre Fayoux
- CRACMO: Centre de Réference des Affections Chroniques et Malformatives de l'œsophage Reference Centre for Rare Oeophageal Diseases CHU Lille LIRIC UMR 995 Univ. Lille Lille France
| | - Antoine Deschildre
- Pediatric Pulmonology and Allergy Department Pole Enfant Jeanne de Flandre Hospital CHU Lille Univ. Lille Lille France
- CRACMO: Centre de Réference des Affections Chroniques et Malformatives de l'œsophage Reference Centre for Rare Oeophageal Diseases CHU Lille LIRIC UMR 995 Univ. Lille Lille France
| | - Frederic Gottrand
- CRACMO: Centre de Réference des Affections Chroniques et Malformatives de l'œsophage Reference Centre for Rare Oeophageal Diseases CHU Lille LIRIC UMR 995 Univ. Lille Lille France
| | - Caroline Thumerelle
- Pediatric Pulmonology and Allergy Department Pole Enfant Jeanne de Flandre Hospital CHU Lille Univ. Lille Lille France
- CRACMO: Centre de Réference des Affections Chroniques et Malformatives de l'œsophage Reference Centre for Rare Oeophageal Diseases CHU Lille LIRIC UMR 995 Univ. Lille Lille France
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Aguilera-Pujabet M, Gahete JAM, Guillén G, López-Fernández S, Martin-Giménez MP, Lloret J, López M. Management of neonates with right-sided aortic arch and esophageal atresia: International survey on IPEG AND ESPES members´ experience. J Pediatr Surg 2018; 53:1923-1927. [PMID: 29241961 DOI: 10.1016/j.jpedsurg.2017.11.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/07/2017] [Accepted: 11/12/2017] [Indexed: 11/20/2022]
Abstract
AIM The optimum surgical approach of neonates with right-sided aortic arch (RAA) and esophageal atresia (EA)/tracheoesophageal fistula (TEF) is still an unsolved question. In order to propose an operative algorithm in the era of endoscopic surgery, we performed an international survey to know the current practice between pediatric endoscopic surgeons. Two of the most important societies in endoscopic pediatric surgery were queried: the International Pediatric Endosurgery Group (IPEG) and the European Society of Paediatric Endoscopic Surgeons (ESPES). MATERIALS AND METHODS During December 2016, an anonymous online-based survey was sent to all IPEG and ESPES members, collecting data regarding perioperative management and surgical repair of EA/TEF with RAA. RESULTS 144 surgeons from 23 countries completed the questionnaire. 69.2% of respondents were IPEG members, 30.8% were ESPES members. 71.5% of members who answered the survey had more than 10years of surgical experience. A preoperative echocardiography was almost uniformly performed (93.1%). 31.9% of the surveyed surgeons had never treated an EA/TEF with RAA. The remaining 98 surveyed surgeons had managed 279 cases of EA/TEF with RAA. Thoracotomy was considered the preferred approach for 54.2% of the surgeons, and 51.9% chose a right-sided approach. When RAA was an intraoperative finding, 76% would perform a contralateral thoracotomy if difficulties arose. Thoracoscopy was preferred by 45.8% of surgeons. If RAA was suspected preoperatively, 63.1% preferred to attempt a left-sided thoracoscopy and only 24.2% would change their approach to a thoracotomy. If RAA was an intraoperative finding and a safe surgical repair could not be achieved through right-sided thoracoscopy, 51.5% of them chose to perform a left sided thoracoscopy, rather than convert to thoracotomy. CONCLUSIONS Preoperative echocardiography performed by experienced examiners helps in surgical planning. Preoperative diagnosis of RAA should not discourage thoracoscopic repair, which is increasingly becoming more popular for the correction of EA/TEF. In case of an unexpected intraoperative diagnosis of RAA or operative difficulties when approaching through the right side, thoracoscopy offers a less aggressive approach. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Monserrat Aguilera-Pujabet
- Department of Pediatric Surgery and Urology, Neonatal Surgical Unit, Universitat Autònoma de Barcelona, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Jose Andres Molino Gahete
- Department of Pediatric Surgery and Urology, Neonatal Surgical Unit, Universitat Autònoma de Barcelona, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Gabriela Guillén
- Department of Pediatric Surgery and Urology, Neonatal Surgical Unit, Universitat Autònoma de Barcelona, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Sergio López-Fernández
- Department of Pediatric Surgery and Urology, Neonatal Surgical Unit, Universitat Autònoma de Barcelona, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Marta Patricia Martin-Giménez
- Department of Pediatric Surgery and Urology, Neonatal Surgical Unit, Universitat Autònoma de Barcelona, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Josep Lloret
- Department of Pediatric Surgery and Urology, Neonatal Surgical Unit, Universitat Autònoma de Barcelona, University Hospital of Vall d'Hebron, Barcelona, Spain
| | - Manuel López
- Department of Pediatric Surgery and Urology, Neonatal Surgical Unit, Universitat Autònoma de Barcelona, University Hospital of Vall d'Hebron, Barcelona, Spain.
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Kudose S, Pineda J, Saito JM, Dehner LP. Aberrant Right Subclavian Artery-Esophageal Fistula in 20-Year-Old with VATER Association. J Pediatr Intensive Care 2017; 6:127-131. [PMID: 31073436 DOI: 10.1055/s-0036-1584812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/02/2016] [Indexed: 10/21/2022] Open
Abstract
Aberrant right subclavian artery (ARSA), the most common aortic arch abnormality, occurs in approximately 0.5 to 1.8% of the general population, with prevalence of up to 25% in those with esophageal atresia. Although ARSA is often asymptomatic, a fistulous tract into esophagus may develop with prolonged nasogastric tube placement or endotracheal intubation and lead to potentially fatal hematemesis. We present a first case of ARSA-esophageal fistula in a 20-year-old woman with VATER association in the absence of an esophageal anomaly and review 28 cases of ARSA-esophageal fistula reported in the literature to date. Requiring nasogastric and endotracheal tube placement for approximately 4 months, the patient had a prolonged hospital course and died after sudden hematemesis. An autopsy demonstrated an ARSA-esophageal fistula and no other source of upper gastrointestinal bleeding. In patients with esophageal atresia requiring prolonged placement of an endotracheal or nasogastric tube, a screening imaging study and corrective surgery may be indicated. Although the mortality rate is still high, timely recognition and repair of ARSA-esophageal fistula appear to be improving. Given the potentially prolonged latency for its development with occasional presence of heralding symptoms, increased awareness may facilitate surgical intervention to prevent a catastrophic exsanguination.
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Affiliation(s)
- Satoru Kudose
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Jose Pineda
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Jacqueline M Saito
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Louis P Dehner
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, United States
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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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9
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Parolini F, Armellini A, Boroni G, Bagolan P, Alberti D. The management of newborns with esophageal atresia and right aortic arch: A systematic review or still unsolved problem. J Pediatr Surg 2016; 51:304-9. [PMID: 26592954 DOI: 10.1016/j.jpedsurg.2015.10.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 08/01/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
Abstract
AIM OF THE STUDY The management of newborns with esophageal atresia (EA) and right aortic arch (RAA) is still an unsolved problem. This study provides a systematic review of epidemiology, diagnosis, management and short-term results of children with EA and RAA. MATERIALS AND METHODS The PubMed database was searched for original studies on children with EA and RAA. In each study, data were extracted for the following outcomes: number of patients, associated anomalies, type of surgical repair, morbidity and mortality rate. RESULTS Eight studies were selected, including 54 patients with EA and RAA. RAA was encountered in 3.6% of infants. Preoperative detection of RAA was reported in 7 of them. In these patients, primary anastomosis was achieved through the right approach in 3 (thoracotomy in 2 and thoracoscopy in 1) while the left approach was the primary choice in 4 (thoracotomy in 2 and thoracoscopy in 2). No significant differences were found between the right and left approaches with regard to leaks (P=0.89), strictures (P=1) or mortality (P=1). In 47/54 patients (87%) RAA was noted during right thoracotomy, and primary anastomosis was achieved through the same approach in 29 (61.7%); conversion to other approaches (left thoracotomy or esophageal substitution) was performed in 15 children (38.3%). No significant differences were found between primary left thoracotomy (LT) and LT after RT with regard to leaks (P=0.89), strictures (P=1) or mortality (P=1). CONCLUSIONS Skills and preferences of the surgeon still guide the choice of surgical approach even when preoperatively faced with RAA. A multicenter, prospective randomized study is strongly required.
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Affiliation(s)
- Filippo Parolini
- Department of Paediatric Surgery, "Spedali Civili" Hospital, Brescia, Italy.
| | - Andrea Armellini
- Department of Paediatric Surgery, "Spedali Civili" Hospital, Brescia, Italy
| | - Giovanni Boroni
- Department of Paediatric Surgery, "Spedali Civili" Hospital, Brescia, Italy
| | - Pietro Bagolan
- Department of Medical and Surgical Neonatology, Bambino Gesu' Research Children's Hospital, Rome, Italy
| | - Daniele Alberti
- Department of Paediatric Surgery, "Spedali Civili" Hospital, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Berthet S, Tenisch E, Miron MC, Alami N, Timmons J, Aspirot A, Faure C. Vascular Anomalies Associated with Esophageal Atresia and Tracheoesophageal Fistula. J Pediatr 2015; 166:1140-1144.e2. [PMID: 25720367 DOI: 10.1016/j.jpeds.2015.01.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 12/16/2014] [Accepted: 01/21/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To report the incidence of congenital vascular anomalies in a cohort of patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) while describing the clinical presentation, diagnosis, and consequences, and to evaluate the diagnostic value of esophagram in diagnosing an aberrant right subclavian artery (ARSA). METHODS All patients born with EA/TEF between 2005 and 2013 were studied. Preoperative echocardiography reports, surgical descriptions of primary esophageal repair, and esophagrams were reviewed retrospectively. RESULTS Of the 76 children born with EA/TEF included in this study, 14 (18%) had a vascular malformation. The incidence of a right aortic arch (RAA) was 6% (5 of 76), and that of an aberrant right subclavian artery (ARSA) was 12% (9 of 76). RAA was diagnosed in the neonatal period by echocardiography (4 of 5) or surgery (1 of 5), and ARSA was diagnosed by echocardiography (7 of 9) or later on the esophagram (2 of 9). Respiratory and/or digestive symptoms occurred in 9 of the 14 patients with vascular malformation. Both long-gap EA and severe cardiac malformations necessitating surgery were significantly associated with vascular anomalies (P<.05). The sensitivity of the esophagram for diagnosing ARSA was 66%, the specificity was 98%, the negative predictive value was 95%, and the positive predictive value was 85%. CONCLUSION ARSA and RAA have an incidence of 12% and 6% respectively, in patients with EA/TEF. A computed tomography angioscan is recommended to rule out such malformations when stenting of the esophagus is indicated, before esophageal replacement surgery, and when prolonged (>2 weeks) use of a nasogastric tube is considered.
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Affiliation(s)
- Stéphanie Berthet
- Division of Pediatric Gastroenterology Hepatology and Nutrition, Sainte-Justine University Health Centre, Montreal, Québec, Canada
| | - Estelle Tenisch
- Division of Pediatric Radiology, Sainte-Justine University Health Centre, Montreal, Québec, Canada
| | - Marie Claude Miron
- Division of Pediatric Radiology, Sainte-Justine University Health Centre, Montreal, Québec, Canada
| | - Nassiba Alami
- Division of Pediatric Cardiology, Sainte-Justine University Health Centre, Montreal, Québec, Canada
| | - Jennifer Timmons
- Division of Surgery, Sainte-Justine University Health Centre, Montreal, Québec, Canada
| | - Ann Aspirot
- Division of Surgery, Sainte-Justine University Health Centre, Montreal, Québec, Canada
| | - Christophe Faure
- Division of Pediatric Gastroenterology Hepatology and Nutrition, Sainte-Justine University Health Centre, Montreal, Québec, Canada.
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Burge DM, Shah K, Spark P, Shenker N, Pierce M, Kurinczuk JJ, Draper ES, Johnson PRV, Knight M. Contemporary management and outcomes for infants born with oesophageal atresia. Br J Surg 2013; 100:515-21. [DOI: 10.1002/bjs.9019] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Reports on the management and outcome of rare conditions, such as oesophageal atresia, are frequently limited to case series reporting single-centre experience over many years. The aim of this study was to identify all infants born with oesophageal atresia in the UK and Ireland to describe current clinical practice and outcomes.
Methods
This was a prospective multicentre cohort study of all infants born with oesophageal atresia and/or tracheo-oesophageal fistula in 2008–2009 in the UK and Ireland to record current clinical management and early outcomes.
Results
A total of 151 infants admitted to 28 paediatric surgical units were identified. Some aspects of perioperative management were universal, including oesophageal decompression, operative technique and the use of transanastomotic tubes. However, there were a number of areas where clinical practice varied considerably, including the routine use of perioperative chest drains, postoperative contrast studies and antireflux medication, with each of these being employed in 30–50 per cent of patients. There was a trend towards routine postoperative ventilation.
Conclusion
The prospective methodology used in this study can help identify practices that all surgeons employ and also those that few surgeons use. Areas of clinical equipoise can be recognized and avenues for further research identified.
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Affiliation(s)
- D M Burge
- Department of Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Shah
- Department of Paediatric Surgery, Oxford, UK
| | - P Spark
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - N Shenker
- Department of Paediatric Surgery, Oxford, UK
| | - M Pierce
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - J J Kurinczuk
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - E S Draper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - M Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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Escobar MA, Welke KF, Holland RM, Caty MG. Esophageal atresia associated with a rare vascular ring and esophageal duplication diverticulum: a case report and review of the literature. J Pediatr Surg 2012; 47:1926-9. [PMID: 23084209 DOI: 10.1016/j.jpedsurg.2012.07.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 07/28/2012] [Accepted: 07/30/2012] [Indexed: 11/28/2022]
Abstract
Esophageal atresia with tracheoesophageal fistula (EA-TEF) associated with a right aortic arch poses a dilemma to the pediatric surgeon, often necessitating an operative approach via a left thoracotomy. A right aortic arch may be associated with a vascular ring, and EA-TEF, too, has been reported in association with a vascular ring. Rarely, esophageal atresia is associated with a second esophageal anomaly, such as a so-called "esophageal lung." To our knowledge, there is no report of all three in one patient. We report the first case of a patient with associated EA-TEF, vascular ring (diverticulum of Kommerell), and esophageal lung. The literature is reviewed for these rare entities.
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Affiliation(s)
- Mauricio A Escobar
- Division of Pediatric Surgery, Mary Bridge Children's Hospital & Health Center, Tacoma, WA 98415, USA.
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Olgun H, Karacan M, Caner I, Oral A, Ceviz N. Congenital cardiac malformations in neonates with apparently isolated gastrointestinal malformations. Pediatr Int 2009; 51:260-2. [PMID: 19405929 DOI: 10.1111/j.1442-200x.2008.02711.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The association of congenital cardiac malformations (CCM) with malformations of the gastrointestinal tract/abdominal wall is known. Nevertheless, the data presently available are derived from patient populations that include some special conditions known to be associated with a high rate of CCM. The aim of the present study was therefore to determine the incidence of cardiac malformations among neonates with apparently isolated malformations of the gastrointestinal tract/abdominal wall. METHODS A total of 201 neonates with apparently isolated gastrointestinal malformations were screened on echocardiography. RESULT Thirty-six (17.9%) of the neonates were diagnosed as having a CCM. When the four most frequent gastrointestinal malformations were evaluated, a CCM was diagnosed in 11/69 (15.9%) with anal atresia, in 9/38 (23.7%) with tracheoesophageal fistula/esophageal atresia, in 2/25 (8%) with diaphragmatic hernia and in 5/17 (29.4%) with intestinal atresia. In 11 of 36 patients (30.6%) with CCM, the cardiac problems were hemodynamically significant, requiring anti-congestive and/or surgical treatment. CONCLUSION A significant number of neonates with apparently isolated gastrointestinal malformations had CCM. Because almost all patients with malformations of the gastrointestinal tract/abdominal wall require early surgical intervention, they should be evaluated on echocardiography to investigate CCM at the earliest opportunity.
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Affiliation(s)
- Hasim Olgun
- Department of Pediatrics, Division of Pediatric Cardiology, Faculty of Medicine, Atatörk University, Erzurum, Turkey.
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Saade E, Setzer N. Anesthetic management of tracheoesophageal fistula repair in a newborn with hypoplastic left heart syndrome. Paediatr Anaesth 2006; 16:588-90. [PMID: 16677272 DOI: 10.1111/j.1460-9592.2005.01807.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present a case of a newborn with hypoplastic left heart syndrome (HLHS) and tracheoesophageal fistula (TEF). The anesthesia management for the repair of the TEF is presented and the management of the unique pathophysiology of the HLHS circulation is discussed.
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Affiliation(s)
- Edouard Saade
- Department of Anesthesiology, University of Texas Medical Branch Galveston and Driscoll Children's Hospital, Corpus Christi, TX, USA.
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Yagyu M, Gitter H, Richter B, Booss D. Esophageal atresia in Bremen, Germany--evaluation of preoperative risk classification in esophageal atresia. J Pediatr Surg 2000; 35:584-7. [PMID: 10770387 DOI: 10.1053/jpsu.2000.0350584] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND/PURPOSE The current study enrolled 113 patients with esophageal atresia (EA) accompanying tracheoesophageal fistula (TEF) (Vogt type IIIb) who were treated at the Central Hospital St. Jürgen Strasse, Department of Pediatric Surgery in Bremen, Germany between 1978 and 1997. METHODS These EA patients were classified into patients preoperatively complicated by respiratory distress syndrome (RDS) or pneumonia and those without complications. In each group, risk factors were classified according to the risk classification described by Spitz et al, and the prognoses and therapeutic problems were evaluated. Based on these results, a new preoperative risk classification consisting of risk factors described by Spitz et al supplemented with RDS and pneumonia was evaluated. RESULTS When the prognoses of EA were evaluated, the survival rate was markedly decreased when RDS or pneumonia alone or more than 2 of 3 factors including major cardiac anomalies and low birth weight were present as preoperative risk factors. Concerning therapeutic problems, the necessity of treatment with delayed primary repair tended to increase when RDS or pneumonia was present as risk factors. However, it was suggested that secure and safe blockage of TEF was still difficult during the initial surgery. CONCLUSIONS During selection of therapeutic strategies for EA, RDS and pneumonia are still considered to be essential as preoperative risk factors for EA. Our new preoperative risk classification consisting of risk factors described by Spitz et al supplemented with RDS and pneumonia appears to clearly reflect the prognoses and therapeutic problems of EA.
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Affiliation(s)
- M Yagyu
- Department of Pediatric Surgery, Central Hospital St Jürgen Strasse, Bremen, Germany
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Kalache KD, Wauer R, Mau H, Chaoui R, Bollmann R. Prognostic significance of the pouch sign in fetuses with prenatally diagnosed esophageal atresia. Am J Obstet Gynecol 2000; 182:978-81. [PMID: 10764484 DOI: 10.1016/s0002-9378(00)70357-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Esophageal atresia may be diagnosed prenatally by ultrasonographic visualization of the blind-ending esophagus during fetal swallowing, which is referred to as the pouch sign. Our purpose was to determine whether this sign can be used to predict outcomes of affected fetuses. STUDY DESIGN Four cases of esophageal atresia diagnosed in our center during the past 2 years were analyzed, in conjunction with 3 cases from published series. Ultrasonographic features of the pouch sign were categorized according to localization. RESULTS In the neck pouch group (n = 3) 1 fetus died in utero and 1 died before a corrective operation could be undertaken. In the only fetus of this group to survive a staged repair was necessary because of a long atretic gap. Conversely, 3 of the 4 fetuses with a mediastinal pouch survived after a successful corrective operation, and primary repair was possible in all cases. CONCLUSIONS The base of the proximal blind-ending esophagus can be clearly localized by means of ultrasonography. Our data suggest that a neck pouch may be associated with an adverse outcome. This information may be useful in counseling parents when esophageal atresia is diagnosed prenatally.
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Affiliation(s)
- K D Kalache
- Unit of Fetal Medicine, Clinic of Obstetrics and Gynecology, Campus Charité Mitte, University Hospital-Medical Faculty of the Humboldt University, Berlin, Germany
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Babu R, Pierro A, Spitz L, Drake DP, Kiely EM. The management of oesophageal atresia in neonates with right-sided aortic arch. J Pediatr Surg 2000; 35:56-8. [PMID: 10646774 DOI: 10.1016/s0022-3468(00)80013-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND/PURPOSE The management of oesophageal atresia (OA) in association with a right-sided aortic arch (RAA) is challenging. It is controversial whether right or left thoracotomy is the most appropriate surgical approach. The aim of this study was to determine the prevalence of RAA in patients with OA and the most appropriate surgical approach. METHODS The case records of all the neonates with OA treated over an 18-year period (1980 through 1997) were reviewed. Patients with RAA were analysed with particular reference to the preoperative investigations, operative approach and findings, and postoperative complications. RESULTS Of the 476 case notes reviewed, 12 (2.5%) had a RAA, and 5 of these infants had major cardiac anomalies. The diagnosis was not suspected on preoperative chest x-ray in any of these infants. In only 1 of the 5 neonates who had a preoperative echocardiogram was RAA suspected. A right thoracic approach was performed in the 11 infants in whom a RAA was not suspected. Immediate conversion to a left thoracotomy with primary anastomosis was carried out in 2 infants. In 2 further infants, fistula ligation alone was performed because of a long gap atresia. Anastomosis via the right thoracotomy was performed in 7 infants. There were 3 anastomotic leaks, 1 intractable stricture, and 1 recurrent fistula. Three patients (25%) had a double aortic arch, and, as a result, a left thoracotomy had to be abandoned in 2. There were 3 deaths, 2 as a result of major cardiac anomalies and 1 related to prematurity and sepsis. CONCLUSIONS RAA occurs in 2.5% of infants with OA. Preoperative chest x-ray and echocardiogram are unreliable as diagnostic modalities. Anastomosis via a right thoracotomy is associated with a 42% leak rate. The presence of a double aortic arch can make the oesophageal anastomosis via a left thoracotomy as difficult as via a right thoracotomy.
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Affiliation(s)
- R Babu
- Department of Paediatric Surgery, Institute of Child Health and Great Ormond Street Hospital for Children, London, England
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