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Borselle D, Grochowski K, Gerus S, Międzybrodzki K, Kołtowski K, Jasińska A, Kamiński A, Patkowski D. Thoracic Musculoskeletal Deformities Following Surgical Treatment of Esophageal Atresia - Thoracoscopic Versus Open Approach: A Retrospective Two Centers Cohort Study. J Pediatr Surg 2024; 59:1719-1724. [PMID: 38594136 DOI: 10.1016/j.jpedsurg.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/07/2024] [Accepted: 03/10/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Thoracic musculoskeletal deformities are significant complications following open correction of esophageal atresia (EA) during long-term follow-up. We aimed to compare the frequency and severity of thoracic musculoskeletal deformities after open and thoracoscopic repair of EA. We hypothesized that fewer deformities would occur following the less invasive thoracoscopic approach. METHODS This retrospective study analyzed patients treated at two pediatric surgery departments in Poland between 2005 and 2021. The patient groups differed in surgical approach, operative techniques, indications for multi-staged surgery, and postoperative complications. The study encompassed all types of EA/TEF. The first group comprised 68 patients who underwent thoracoscopic esophageal atresia repair (Wroclaw), while the second group involved 44 patients who underwent open repair (Warsaw). Clinical data were retrospectively reviewed, with results considered significant at p < 0.05. RESULTS The median age at examination was 6 years in the thoracoscopy group and 5.5 years in the thoracotomy group. In the thoracoscopy group, 53 out of 68 patients (77.9%) and in the thoracotomy group - 35 out of 44 patients (79.5%) were treated in one stage. The incidence of thoracic musculoskeletal deformities was significantly lower in the thoracoscopy group (1.5%) compared to the thoracotomy group (34.1%, p < 0.001). Scoliosis occurred significantly more often after thoracotomy (13.6% vs 1.5%, p = 0.016). There was no rib fusion (0% vs 37.1%, p < 0.001) and no scoliosis of =>20° (0% vs 6.8%, p = 0.058) after thoracoscopy. The coincidence of rib fusion and scoliosis was significant (9.1%, p = 0.022) for the open approach. In the thoracotomy group, multi-staged surgery and more frequent reoperations due to major complications were significantly associated with an increased occurrence of deformities. None of the patients after thoracoscopic multi-stage or complicated EA/TEF repair developed scoliosis. CONCLUSIONS The frequency and severity of thoracic musculoskeletal deformities were significantly lower after the thoracoscopic approach. Thoracoscopy may be a more advantageous and preferred surgical approach for the EA/TEF treatment, although further randomized, controlled studies are necessary. Post-thoracotomy scoliosis may progress to a severity requiring surgery.
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Affiliation(s)
- Dominika Borselle
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland.
| | - Konrad Grochowski
- Department of Pediatric Surgery, Pediatric Urology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Sylwester Gerus
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Krzysztof Kołtowski
- Department of Pediatric Orthopedics and Traumatology, University Hospital of Jan Mikulicz-Radecki, Wroclaw, Poland
| | - Aleksandra Jasińska
- Department of Pediatric Surgery, Pediatric Urology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Kamiński
- Department of Pediatric Surgery, Pediatric Urology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Dariusz Patkowski
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland
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Borselle D, Gerus S, Bukowska M, Patkowski D. Birth weight and thoracoscopic approach for patients with esophageal atresia and tracheoesophageal fistula-a retrospective cohort study. Surg Endosc 2024; 38:5076-5085. [PMID: 39020118 PMCID: PMC11362424 DOI: 10.1007/s00464-024-11063-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/07/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND This study aimed to analyze the results, feasibility and safety of the thoracoscopic approach for patients with esophageal atresia with tracheoesophageal fistula (EA/TEF) depending on the patient's birth weight. METHODS The study involved only type C and D EA/TEF. Among the analyzed parameters were the patients' characteristics, surgical treatment and post-operative complications: early mortality, anastomosis leakage, anastomosis strictures, chylothorax, TEF recurrence, and the need for fundoplication or gastrostomy. RESULTS 145 consecutive newborns underwent thoracoscopic EA with TEF repair. They were divided into three groups-A (N = 12 with a birth weight < 1500 g), B (N = 23 with a birth weight ≥ 1500 g but < 2000 g), and C-control group (N = 110 with a birth weight ≥ 2000 g). Primary one-stage anastomosis was performed in 11/12 (91.7%) patients-group A, 19/23 (82.6%)-group B and 110 (100%)-group C. Early mortality was 3/12 (25%)-group A, 2/23 (8.7%)-group B, and 2/110 (1.8%)-group C and was not directly related to the surgical repair. There were no significant differences in operative time and the following complications: anastomotic leakage, recurrent TEF, esophageal strictures, and chylothorax. There were no conversions to an open surgery. Fundoplication was required in 0%-group A, 4/21 (19.0%)-group B, and 2/108 (1.9%)-group C survivors. Gastrostomy was performed in 1/9 (11.1%)-group A, 3/21 (14.3%)-group B and 0%-group C. CONCLUSION In an experienced surgeon's hands, even in the smallest newborns, the thoracoscopic approach may be safe, feasible, and worthy of consideration. Birth weight seems to be not a direct contraindication to the thoracoscopic approach.
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Affiliation(s)
- Dominika Borselle
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
| | - Sylwester Gerus
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Monika Bukowska
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Dariusz Patkowski
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
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Yalcin S, Bhatia AM, He Z, Wulkan ML. Short- and Long-Term Outcomes of Thoracoscopic and Open Repair For Esophageal Atresia and Tracheoesophageal Fistula. J Pediatr Surg 2024:161662. [PMID: 39218728 DOI: 10.1016/j.jpedsurg.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The aim was to evaluate short- and long-term outcomes for thoracoscopic repair of EA/TEF and compare with open repair. METHODS Patients who underwent EA/TEF repair during 2000-2020 were evaluated retrospectively. Patients with delayed repair were excluded. Demographic, operative, outcome data was collected. Outcomes were compared using Wilcoxon-rank sum tests for continuous, Chi-squared/Fisher's exact tests for categorical data. RESULTS There were 104 patients with primary repair, 49 (47.1%) underwent thoracoscopic repair per surgeon's choice. Type C accounted for 101 (97.1%) of the cases. Gestational age and birth weight were higher in the thoracoscopy group (p = 0.001). The rate of ≥3 VACTERL anomalies was higher in the OR group (p = 0.016). Operative time, rate of anastomotic leak, time to first oral feeding were similar (p > 0.05). Thoracoscopy group had decreased length of ventilation (p = 0.026) and length of stay (p = 0.029). The incidence of anastomotic stricture was higher in the thoracoscopy group (p = 0.012). Recurrent TEF was one case in each group. Rates of tube feeding at discharge and in first year were similar (p > 0.05), rate in third year was decreased (p = 0.032) in the thoracoscopy group. Rates of anti-reflux medication in first and third years, and fundoplication rate were similar (p > 0.05). CONCLUSIONS Many of the short- and long-term outcomes are comparable between thoracoscopic and open repair of EA/TEF. Length of ventilation, length of stay are decreased in the thoracoscopy group. Anastomotic stricture is higher, the need for long-term tube feeding is lower after thoracoscopic repair. Although these results could be affected by selection bias, they are still promising for advancing thoracoscopic repair of EA/TEF safely and efficiently. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sule Yalcin
- Division of Pediatric Surgery, Department of Surgery, Emory University, School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Amina M Bhatia
- Division of Pediatric Surgery, Department of Surgery, Emory University, School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Zhulin He
- Department of Pediatrics, Biostatistics Core, Emory University School of Medicine, Atlanta, GA, USA
| | - Mark L Wulkan
- Division of Pediatric Surgery, Department of Surgery, Emory University, School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA; Department of Surgery, Akron Children's Hospital, Akron, OH, USA.
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Pérez-Bertólez S, Godoy-Lenz J. Primary repair of esophageal atresia Gross type C via thoracoscopic magnetic compression anastomosis: Is it the best option? World J Gastrointest Surg 2024; 16:1474-1481. [PMID: 38817291 PMCID: PMC11135306 DOI: 10.4240/wjgs.v16.i5.1474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/03/2024] [Accepted: 04/25/2024] [Indexed: 05/23/2024] Open
Abstract
Magnetic compression anastomosis is a promising treatment option for patients with complex esophageal atresia; but, at the present time, should not be the first therapeutic option in those cases where the surgeon can perform a primary anastomosis of the two ends of the esophagus with acceptable tension.
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Affiliation(s)
- Sonia Pérez-Bertólez
- Department of Pediatric Surgery, Sant Joan de Deu Hospital, University of Barcelona, Barcelona 08950, Spain
| | - Jorge Godoy-Lenz
- Department of Pediatric Surgery, Clínica Alemana of Santiago, Santiago 7650568, Chile
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van Hal AFRL, Vlot J, van Rosmalen J, Wijnen RMH, van Gils-Frijters APJM, Gischler SJ, Staals LM, IJsselstijn H, Rietman AB. Minimally invasive surgical approach in children treated for oesophageal atresia is associated with attention problems at school age: a prospective cohort study. Eur J Pediatr 2024; 183:2131-2140. [PMID: 38363392 PMCID: PMC11035457 DOI: 10.1007/s00431-024-05449-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/11/2024] [Accepted: 01/21/2024] [Indexed: 02/17/2024]
Abstract
The long-term neurodevelopment of children born with oesophageal atresia (OA) is unclear. Therefore, we assessed the neurocognitive domains and their predictors. Patients born with OA between February 2006 and December 2014, who were routinely seen at eight years as part of a structured prospective longitudinal follow-up program, were included. Main outcome measures were need for school support, performance in various neurocognitive domains and potential predictors of neurocognitive problems. We analysed data of 65 children with a mean (SD) age of 8.1 (0.2) years, of whom 89% with OA type C. Thirty-five (54%) surgical corrections were minimally invasive; the median (interquartile range) duration of exposure to anaesthetics in the first 24 months was 398 (296 - 710) minutes. Forty-four (68%) attended regular education without extra support and intelligence was within normal range (99-108). More than 50% had z-scores ≤ -2 on one or more neurocognitive domains, of which attention was the most frequently affected domain. The speed on the sustained attention task was significantly below normal (z-score -1.48 (2.12), p < .001), as was fluctuation of sustained attention (z-score -3.19 (3.80), p < .001). The minimally invasive approach and a lower socio-economic status (both p = 0.006) proved significant predictors for sustained attention problems in multivariable analyses. Conclusion: Children who undergo minimally invasive surgery for OA correction are at risk for sustained attention problems at school age. Future studies unravelling the effects of perioperative events on neurodevelopment should lead to optimal surgical, anaesthesiological, and intensive care management in the neonatal period. What is Known: • School-aged children born with oesophageal atresia have normal intelligence but problems with sustained attention at eight years. What is New: • Oesophageal atresia patients, who undergo minimally invasive surgery or who have a background of lower socioeconomic status are at serious risk for sustained attention problems at school age. • Moreover, those who have been intubated for a longer period are at risk for stronger fluctuations in sustained attention.
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Affiliation(s)
- Anne-Fleur R L van Hal
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - John Vlot
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Annabel P J M van Gils-Frijters
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Saskia J Gischler
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Lonneke M Staals
- Department of Anaesthesiology, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Hanneke IJsselstijn
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - André B Rietman
- Department of Paediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
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Hattori K, Kawashima H, Ishimaru T, Yanagida Y, Miyake K, Iguchi M, Oiki H, Maeda S, Ihara Y. Musculoskeletal deformities after thoracoscopic versus conventional open repair for esophageal atresia. Asian J Surg 2024; 47:968-972. [PMID: 38030485 DOI: 10.1016/j.asjsur.2023.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/10/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The superiority of thoracoscopic repair (TR) over conventional open repair (COR) for esophageal atresia, especially in terms of long-term outcomes, remains to be investigated. The aim of this study was to compare short- and long-term results between TR and COR group. METHODS Patients who underwent TR or COR for esophageal atresia without other predispositions to musculoskeletal deformities (2003-2016) and had been followed up for a minimum of 5 years were retrospectively reviewed. Musculoskeletal deformities (e.g., scoliosis, chest wall asymmetry, and rib deformities) were mainly evaluated based on the most recent chest radiographs. RESULTS Nine and eight patients were included in the TR and COR groups, respectively; the mean follow-up period was 8.7 and 11.5 years, respectively (p = 0.14). These groups had similar epidemiological characteristics and rates of postoperative complications. Musculoskeletal deformities developed significantly less frequently in the TR group versus the COR group (11 % vs. 88 %, p < 0.05; scoliosis: 0 % vs. 38 %, p = 0.08; chest wall asymmetry: 11 % vs. 50 %, p = 0.14; and rib deformities: 11 % vs. 88 %, p < 0.05, respectively). CONCLUSION TR was associated with a decreased incidence of musculoskeletal deformities and comparable complication rates versus COR for esophageal atresia repair. TR may achieve better long-term outcomes in this setting.
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Affiliation(s)
- Kengo Hattori
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan; Department of Pediatric Surgery, Takatsuki General Hospital, Japan.
| | - Hiroshi Kawashima
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Tetsuya Ishimaru
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshitsugu Yanagida
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kazue Miyake
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Masashi Iguchi
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hironobu Oiki
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Syohei Maeda
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshiyuki Ihara
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
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Zhang M, Huang J, Jin Z, Zhang X, Zhou Y, Chi S, Rong L, Zhang Y, Cao G, Li S, Tang ST. Comparison of robotic versus thoracoscopic repair for congenital esophageal atresia: a propensity score matching analysis. Int J Surg 2024; 110:891-901. [PMID: 37983822 PMCID: PMC10871573 DOI: 10.1097/js9.0000000000000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Despite the rapid advancement of robotic surgery across various surgical domains, only cases of robotic repair (RR) for neonates with esophageal atresia (EA) have been reported. Comprehensive studies comparing RR and thoracoscopic repair (TR) are lacking. The authors aimed to compare the safety and efficacy of RR and TR for EA. METHODS A retrospective multicenter study was conducted on 155 EA neonates undergoing RR (79 patients) or TR (76 patients) between August 2020 and February 2023 using propensity score matching. Asymmetric port distribution and step-trocar insertion techniques were applied during RR. Demographics and surgical outcomes were compared. RESULTS After matching, 63 patients (out of 79) in RR group and 63 patients (out of 76) in TR group were included. There were no significant differences in short-term outcomes between two groups, except for longer total operative time (173.81 vs. 160.54 min; P <0.001) and shorter anastomotic time (29.52 vs. 40.21 min; P <0.001) in RR group. Compared with TR group, the RR group had older age at surgery (8.00 vs. 3.00 days; P <0.001), but a comparable pneumonia rate. More importantly, the incidence of anastomotic leakage (4.76 vs. 19.05%, P =0.013), anastomotic stricture (15.87 vs. 31.74%, P =0.036) within 1 year postoperatively, and unplanned readmission (32.26 vs. 60.00%, P =0.030) within 2 years postoperatively were lower in RR group than in TR group. CONCLUSIONS RR is a technically safe and effective option for EA patients. This approach delays the age of surgery without increasing respiratory complication rates while reducing the incidence of postoperative anastomotic complications and unplanned readmission.
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Affiliation(s)
- Mengxin Zhang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Jinshi Huang
- Department of Neonatal Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing
| | - Zhu Jin
- Provincial Key Laboratory of Research in Structure Birth Defect Disease and Department of Pediatric Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Xi Zhang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Ying Zhou
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Shuiqing Chi
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Liying Rong
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Yang Zhang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Guoqing Cao
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Shuai Li
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Shao-tao Tang
- Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
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Hall NJ, Kitteringham L, Ron O, Stedman F, Stanton M, Wheeler R, Jones C, Smyth R, Keys C. A Minimally Interventional Approach to Oesophageal Atresia Repair With Early Enteral Feeding is Safe, Optimises Neonatal Outcomes, and Reduces Resource use. J Pediatr Surg 2024; 59:6-9. [PMID: 37867045 DOI: 10.1016/j.jpedsurg.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE Recent series of newborn Oesophageal Atresia (OA) repair continue to report widespread use of chest drains, gastrostomy, routine contrast studies and parenteral nutrition (PN) despite evidence suggesting these are superfluous. We report outcomes using a minimally interventional approach to post-operative recovery. METHODS Ethically approved (15/WA/0153), single-centre, retrospective case-note review of consecutive infants with OA 2000-2022. Infants with OA and distal trache-oesophageal fistula undergoing primary oesophageal anastomosis at initial surgery were included (including those with comorbidities such as duodenal atresia, anorectal malformation and cardiac lesions). Our practice includes routine use of a trans-anastomotic tube (TAT), no routine chest drain nor gastrostomy, early enteral and oral feeding, no routine PN and no routine contrast study. Data are median (IQR). RESULTS Of total 186 cases of OA treated during the time period, 157 met the inclusion criteria of which 2 were excluded as casenotes unavailable. TAT was used in 150 infants. A chest drain was required in 13 (8%) and two infants had a neonatal gastrostomy. Enteral feeds were started on postoperative day 2 (2-3), full enteral feeds established by day 4 (4-6) and oral feeds started on day 5 (4-8). PN was required in 15%. Median postoperative length of stay was 10 days (8-17). Progress was quicker in term infants than preterm. One infant died of cardiac disease prior to neonatal discharge. Two planned post-operative contrast studies were performed (surgeon preference) and a further 7 due to clinical suspicion of anastomotic leak. Contrast study was therefore avoided in 94%. There were 2 anastomotic leaks; both presented clinically at day 4 and day 8 after oral feeds had been started. CONCLUSION Our minimally interventional approach is safe. It facilitates prompt recovery with lower resource use, reduced demand on nursing staff, reduced radiation burden, and early discharge home compared to published series without adversely affecting outcomes. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Nigel J Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK.
| | - Lara Kitteringham
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Ori Ron
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Francesca Stedman
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Michael Stanton
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Robert Wheeler
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Ceri Jones
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Rachel Smyth
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Charles Keys
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
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Krishnan N, Pakkasjärvi N, Kainth D, Danielson J, Verma A, Yadav DK, Goel P, Anand S. Role of Magnetic Compression Anastomosis in Long-Gap Esophageal Atresia: A Systematic Review. J Laparoendosc Adv Surg Tech A 2023; 33:1223-1230. [PMID: 37603306 DOI: 10.1089/lap.2023.0295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
Background: Magnetic compression anastomosis (MCA) is an alternative technique for patients with long-gap esophageal atresia (EA). It allows for preservation of the native esophagus. We aimed to systematically summarize the current literature on MCA in EA. Methods: Studies where neonates with EA were treated with MCA devices were included, while studies on esophageal stenosis were excluded. All clinical studies, including comparative studies, case series, and case reports, were eligible for inclusion. Methodological quality assessment was performed using a validated tool. Results: Twelve studies with a total of 42 patients were included in this review. There was a wide variation among these studies with regard to the time of initiation of MCA (1 day to 7 months), procedure time (13-320 minutes), and magnet characteristics (strength, size, and shape of the magnets used). The time to achieve anastomosis ranged from 1 to 12 days. Stricture at the anastomotic site was reported in almost all the patients, which required multiple endoscopic dilatations (median no. of dilatations/patient = 9.8). Stent placement for refractory stricture was required in 9 (21%) patients, and surgery for stricture was required in 6 (14%) patients. Long-term outcomes included esophageal dysmotility (n = 3) and recurrent pulmonary infections (n = 3) were reported in only four studies. Conclusion: As per the findings of this review, neonates with long-gap EA undergoing MCA would invariably require multiple sittings of endoscopic dilatations (median no. of dilatations/patient = 9.8). Also, there is a wide variation among the included studies in terms of the procedure of MCA. Future studies with a standardized procedure for achieving MCA are needed to determine additional outcomes in this fragile patient population.
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Affiliation(s)
- Nellai Krishnan
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Niklas Pakkasjärvi
- Department of Pediatric Surgery, Turku University Hospital, Turku, Finland
- Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden
| | - Deepika Kainth
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Johan Danielson
- Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden
| | - Ajay Verma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra Kumar Yadav
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prabudh Goel
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sachit Anand
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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Guo Y, Hinoki A, Deie K, Tainaka T, Sumida W, Makita S, Okamoto M, Takimoto A, Yasui A, Takada S, Nakagawa Y, Kato D, Maeda T, Amano H, Kawashima H, Uchida H, Shirota C. Anastomotic time was associated with postoperative complications: a cumulative sum analysis of thoracoscopic repair of tracheoesophageal fistula in a single surgeon's experience. Surg Today 2023; 53:1363-1371. [PMID: 37087700 DOI: 10.1007/s00595-023-02687-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/02/2023] [Indexed: 04/24/2023]
Abstract
PURPOSE This study aimed to evaluate the learning curve of thoracoscopic repair of tracheoesophageal fistula (TEF) by a single surgeon using a cumulative sum (CUSUM) analysis. METHODS Prospective clinical data of consecutive Gross type-C TEF repairs performed by a pediatric surgeon from 2010 to 2020 were recorded. CUSUM charts for anastomosis and operating times were generated. The learning curves were compared with the effect of accumulation based on case experience. RESULTS For 33 consecutive cases, the mean operative and anastomosis times were 139 ± 39 min and 3137 ± 1110 s, respectively. Significant transitions beyond the learning phase for total operating and anastomosis times were observed at cases 13 and 17. Both the total operating time and anastomosis time were significantly faster in the proficiency improvement phase than in the initial learning phase. Postoperative complications significantly decreased after the initial anastomosis learning phase but not after the initial total operating learning phase. CONCLUSIONS Thoracoscopic repair of TEF is considered safe and feasible after 13 cases, where the surgeon can improve their proficiency with the total operation procedure, and 17 cases, which will enable the surgeon to achieve proficiency in anastomosis. Postoperative complications significantly decreased after gaining familiarity with the anastomosis procedure through the learning phase.
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Affiliation(s)
- Yaohui Guo
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akinari Hinoki
- Department of Rare/Intractable Cancer Analysis Research, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kyoichi Deie
- Department of Saitama Prefectural Children's Medical Center, Saitama, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masamune Okamoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Aitarou Takimoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiro Yasui
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunya Takada
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoichi Nakagawa
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daiki Kato
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Maeda
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hizuru Amano
- Department of Rare/Intractable Cancer Analysis Research, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Kawashima
- Department of Saitama Prefectural Children's Medical Center, Saitama, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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11
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Zou C, Dong J, Xu G, Xia R, Xiao Y, Li M, Li B, Li B, Zhou C. Thoracoscopic Versus Open Repair for Oesophageal Atresia: A Retrospective Cohort Study of 359 Patients at a Single Center. J Pediatr Surg 2023; 58:2069-2074. [PMID: 37321938 DOI: 10.1016/j.jpedsurg.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/26/2023] [Accepted: 05/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND This study aimed to define the effectiveness of thoracoscopic versus open repair of gross type C oesophageal atresia (EA) based on the experience of a single centre over a decade. METHODS This retrospective cohort study included patients who were admitted to Hunan Children's Hospital between January, 2010 and December, 2021 and underwent repair surgery for type C EA. RESULTS A total of 359 patients underwent type C EA repair during the study period, of which 142 were completed via an open approach and 217 were attempted via a thoracoscopic approach (seven converted to open surgery). There were no differences in the demographics or comorbidities between the patients of thoracoscopy and thoracotomy (open repair) groups. The median operating time was 109 [90, 133] min in the thoracoscopic surgery group, which was slightly shorter than that in the open repair group (115 [102, 128] min, p = 0.059). Anastomotic leakage occurred in 41 (18.9%) and 35 (24.6%) infants in the thoracoscopic and open surgery groups, respectively (p = 0.241). Thirteen patients (3.6%) died in the hospital without significant differences in the repair approach. With a median follow-up of 23.7 months, 38 (13.6%) participants had one or more anastomotic strictures requiring dilatation, without significant differences in the repair approach (p = 0.994). CONCLUSIONS Thoracoscopic repair of congenital EA is safe, and has perioperative and medium-term outcomes similar to those of open surgery. This technique is recommended only in hospitals with experienced teams of endoscopic paediatric surgeons and anaesthesiologists.
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Affiliation(s)
- Chanjuan Zou
- Department of Fetal & Neonatal Surgery, Hunan Children's Hospital, Changsha, 410007, China
| | - Jie Dong
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, 410007, China
| | - Guang Xu
- Department of Fetal & Neonatal Surgery, Hunan Children's Hospital, Changsha, 410007, China
| | - Renpeng Xia
- Department of Fetal & Neonatal Surgery, Hunan Children's Hospital, Changsha, 410007, China
| | - Yong Xiao
- Department of Fetal & Neonatal Surgery, Hunan Children's Hospital, Changsha, 410007, China
| | - Ming Li
- Department of Fetal & Neonatal Surgery, Hunan Children's Hospital, Changsha, 410007, China
| | - Bo Li
- Department of Fetal & Neonatal Surgery, Hunan Children's Hospital, Changsha, 410007, China
| | - Bixiang Li
- Department of Fetal & Neonatal Surgery, Hunan Children's Hospital, Changsha, 410007, China
| | - Chonggao Zhou
- Department of Fetal & Neonatal Surgery, Hunan Children's Hospital, Changsha, 410007, China.
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12
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König TT, Frankenbach ML, Gianicolo E, Holler AS, von Sochaczewski CO, Wessel L, Widenmann A, Klos L, Kolb S, Siaplaouras J, Niessner C. Habitual physical activity in patients born with oesophageal atresia: a multicenter cross-sectional study and comparison to a healthy reference cohort matched for gender and age. Eur J Pediatr 2023:10.1007/s00431-023-04923-3. [PMID: 36976316 PMCID: PMC10257632 DOI: 10.1007/s00431-023-04923-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/29/2023]
Abstract
Oesophageal atresia (EA) is associated with life-long gastrointestinal and respiratory morbidity and other associated malformations. The aim of this study is to compare physical activity (PA) levels of children and adolescents with and without EA. A validated questionnaire (MoMo-PAQ) was used to evaluate PA in EA patients EA (4-17 years), who were randomly matched for gender and age (1:5) with a representative sample of the Motorik-Modul Longitudinal Study (n = 6233). Sports activity per week (sports index) and minutes of moderate to vigorous physical activity per week (MVPA minutes) were calculated. Correlations between PA and medical factors were analysed. In total, 104 patients and 520 controls were included. Children with EA were significantly less active at higher intensities (mean MPVA minutes 462; 95% confidence interval (CI): 370-554) compared to controls (626; 95% CI: 576-676), although there was no statistically significant difference in the sports index (187; 95% CI: 156-220 versus 220; 95% CI: 203-237). A lower mean weight-for-age and height-for-age, additional urogenital (r = - 0.20, p = 0.04) or anorectal malformation (r = - 0.24, p = 0.01) were associated with fewer MVPA minutes. For other medical factors (prematurity, type of repair, congenital heart disease, skeletal malformation or symptom load), no statistically significant association with PA was found. Conclusion: EA patients participated in PA at a similar level but lower intensities compared to the reference cohort. PA in EA patients was largely independent of medical factors. TRIAL REGISTRATION German Clinical Trials Register (ID: DRKS00025276) on September 6, 2021. WHAT IS KNOWN • Oesophageal atresia is associated with a low body weight and height, delayed development of motor skills and impaired lung function and exercise capacity. WHAT IS NEW • Patients with oesophageal atresia have a similar amount of sports activity per week but engage significantly less in moderate to vigorous physical activities compared to peers. • Physical activity was associated with weight-for-age and height-for-age, but largely independent of symptom load and other medical factors.
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Affiliation(s)
- Tatjana Tamara König
- Department of Pediatric Surgery, Universitätsmedizin, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany.
| | - Maria-Luisa Frankenbach
- Department of Pediatric Surgery, Universitätsmedizin, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Emilio Gianicolo
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Universitätsmedizin, Johannes Gutenberg-University Mainz, Mainz, Germany
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Anne-Sophie Holler
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Christina Oetzmann von Sochaczewski
- Sektion Kinderchirurgie, Klinik und Poliklinik Für Allgemein-, Viszeral-, Thorax- Und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Germany
| | - Lucas Wessel
- Pediatric Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Anke Widenmann
- Patient Organisation for Esophageal Diseases KEKS e.V., Stuttgart, Germany
| | - Leon Klos
- Institute of Sports and Sports Science (IfSS), Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Simon Kolb
- Institute of Sports and Sports Science (IfSS), Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | - Claudia Niessner
- Institute of Sports and Sports Science (IfSS), Karlsruhe Institute of Technology, Karlsruhe, Germany
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13
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Gebreselassie HA, Tadesse MM, Woldeselassie HG. Thoracotomy in Children: Review from a Low-Income Country. Pediatric Health Med Ther 2023; 14:99-106. [PMID: 36937243 PMCID: PMC10019342 DOI: 10.2147/phmt.s398368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/09/2023] [Indexed: 03/13/2023] Open
Abstract
Background Thoracotomy is indicated for several congenital and acquired disorders in children. It is among the surgical procedures which require a well-trained and dedicated surgical, anesthesia and critical care team which can be difficult to assemble in a low-income country setup. As the pattern and outcome of thoracotomy in children remained unreported from such setting, this study aims to shed light on this matter. Methodology A descriptive cross-sectional review was conducted. Children who have undergone thoracotomy for non-cardiac pathologies were included in the study. Demographic and clinical data were collected by chart review. Frequencies and percentages were used to describe categorical variables while mean, median, standard deviation and interquartile range were calculated for continuous variables. Results A total of 68 patients were operated on in the study period, out of which 44 (64.7%) were males. The mean ages of the children at the time of diagnosis and procedure were 4.05 ± 3.9 years and 4.14 ± 4.03 years, respectively. The most common indication for thoracotomy was pulmonary hydatid cyst (17; 25%) followed by congenital lobar emphysema (11; 16.2%). Muscle sparing posterolateral thoracotomy was the most common approach in 66 (97.1%) patients. The analgesic medications that were used in the post-operative period were paracetamol, diclofenac, ibuprofen, tramadol and morphine. Combined analgesics were administered in two-thirds of the patients while a single analgesic was used in the rest of the children. No regional blocks were administered post operatively as pediatric size catheters were not available. The morbidity and mortality rates were found to be 11.8% and 8.8%, respectively. Conclusion The most common indication for thoracotomy in this study was pulmonary hydatid cyst. The provision of post-thoracotomy analgesia in our institution is suboptimal as evidenced by no use of regional blocks and poor practice of administering multimodal analgesia. Thoracotomy was associated with fairly high morbidity and mortality.
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Affiliation(s)
- Hana Abebe Gebreselassie
- Department of Surgery, Pediatrics Surgery Unit, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Hanna Getachew Woldeselassie
- Department of Surgery, Pediatrics Surgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
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14
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Systematic review of long term follow-up and transitional care in adolescents and adults with esophageal atresia - why is transitional care mandatory? Eur J Pediatr 2023; 182:2057-2066. [PMID: 36905437 PMCID: PMC10175361 DOI: 10.1007/s00431-023-04893-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE to review recent literature concerning long-term health issues and transitional care in esophageal atresia (EA) patients. PubMed, Scopus, Embase and Web of Science databases were screened for studies regarding EA patients aged more than or equal to 11 years, published between August 2014 and June 2022. Sixteen studies involving 830 patients were analyzed. Mean age was 27.4 years (range 11-63). EA subtype distribution was: type C (48.8%), A (9.5%), D (1.9%), E (0.5%) and B (0.2%). 55% underwent primary repair, 34.3% delayed repair, 10.5% esophageal substitution. Mean follow-up was 27.2 years (range 11-63). Long-term sequelae were: gastro-esophageal reflux (41.4%), dysphagia (27.6%), esophagitis (12.4%), Barrett esophagus (8.1%), anastomotic stricture (4.8%); persistent cough (8.7%), recurrent infections (4.3%) and chronic respiratory diseases (5.5%). Musculo-skeletal deformities were present in 36 out of 74 reported cases. Reduced weight and height were detected in 13.3% and 6% cases, respectively. Impaired quality of life was reported in 9% of patients; 9.6% had diagnosis or raised risk of mental disorders. 10.3% of adult patients had no care provider. Meta-analysis was conducted on 816 patients. Estimated prevalences are: GERD 42.4%, dysphagia 57.8%, Barrett esophagus 12.4%, respiratory diseases 33.3%, neurological sequelae 11.7%, underweight 19.6%. Heterogeneity was substantial (> 50%). Conclusion: EA patients must continue follow-up beyond childhood, with a defined transitional-care path by a highly specialized multidisciplinary team due to the multiple long-term sequelae. WHAT IS KNOWN • Survival rates of esophageal atresia patients is now more than 90% thanks to the improvements in surgical techniques and intensive care, therefore patients' needs throughout adolescence and adulthood must be taken into account. WHAT IS NEW • This review, by summarizing recent literature concerning long term sequelae of esophageal atresia, may contribute to raise awareness on the importance of defining standardized protocols of transitional and adulthood care for esophageal atresia patients.
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15
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Marquart JP, Bowder AN, Bence CM, St Peter SD, Gadepalli SK, Sato TT, Szabo A, Minneci PC, Hirschl RB, Rymeski BA, Downard CD, Markel TA, Deans KJ, Fallat ME, Fraser JD, Grabowski JE, Helmrath MA, Kabre RD, Kohler JE, Landman MP, Lawrence AE, Leys CM, Mak GZ, Port E, Saito J, Silverberg J, Slidell MB, Wright TN, Lal DR. Thoracoscopy versus thoracotomy for esophageal atresia and tracheoesophageal fistula: Outcomes from the Midwest Pediatric Surgery Consortium. J Pediatr Surg 2023; 58:27-33. [PMID: 36283849 DOI: 10.1016/j.jpedsurg.2022.09.015] [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: 08/26/2022] [Accepted: 09/16/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND/PURPOSE Controversy persists regarding the ideal surgical approach for repair of esophageal atresia with tracheoesophageal fistula (EA/TEF). We examined complications and outcomes of infants undergoing thoracoscopy and thoracotomy for repair of Type C EA/TEF using propensity score-based overlap weights to minimize the effects of selection bias. METHODS Secondary analysis of two databases from multicenter retrospective and prospective studies examining outcomes of infants with proximal EA and distal TEF who underwent repair at 11 institutions was performed based on surgical approach. Regression analysis using propensity score-based overlap weights was utilized to evaluate outcomes of patients undergoing thoracotomy or thoracoscopy for Type C EA/TEF repair. RESULTS Of 504 patients included, 448 (89%) underwent thoracotomy and 56 (11%) thoracoscopy. Patients undergoing thoracoscopy were more likely to be full term (37.9 vs. 36.3 weeks estimated gestational age, p < 0.001), have a higher weight at operative repair (2.9 vs. 2.6 kg, p < 0.001), and less likely to have congenital heart disease (16% vs. 39%, p < 0.001). Postoperative stricture rate did not differ by approach, 29 (52%) thoracoscopy and 198 (44%) thoracotomy (p = 0.42). Similarly, there was no significant difference in time from surgery to stricture formation (p > 0.26). Regression analysis using propensity score-based overlap weighting found no significant difference in the odds of vocal cord paresis or paralysis (OR 1.087 p = 0.885), odds of anastomotic leak (OR 1.683 p = 0.123), the hazard of time to anastomotic stricture (HR 1.204 p = 0.378), or the number of dilations (IRR 1.182 p = 0.519) between thoracoscopy and thoracotomy. CONCLUSION Infants undergoing thoracoscopic repair of Type C EA/TEF are more commonly full term, with higher weight at repair, and without congenital heart disease as compared to infants repaired via thoracotomy. Utilizing propensity score-based overlap weighting to minimize the effects of selection bias, we found no significant difference in complications based on surgical approach. However, our study may be underpowered to detect such outcome differences owing to the small number of infants undergoing thoracoscopic repair. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- John P Marquart
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 N 92nd St, Suite 320, Milwaukee, WI 53226, USA.
| | - Alexis N Bowder
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 N 92nd St, Suite 320, Milwaukee, WI 53226, USA
| | - Christina M Bence
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 N 92nd St, Suite 320, Milwaukee, WI 53226, USA
| | - Shawn D St Peter
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, USA
| | - Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Thomas T Sato
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 N 92nd St, Suite 320, Milwaukee, WI 53226, USA
| | - Aniko Szabo
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 N 92nd St, Suite 320, Milwaukee, WI 53226, USA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43206, USA
| | - Ronald B Hirschl
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Beth A Rymeski
- Department of Pediatric Surgery, Cincinnati Children's Hospital, 3333 Burnet Ave, ML 2023, Cincinnati, OH 45229, USA
| | - Cynthia D Downard
- Department of Surgery, Division of Pediatric Surgery, University of Louisville School of Medicine, 530 S. Jackson St, Louisville, KY 40202, USA
| | - Troy A Markel
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Emerson Hall, Indianapolis, IN 46202, USA
| | - Katherine J Deans
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43206, USA
| | - Mary E Fallat
- Department of Surgery, Division of Pediatric Surgery, University of Louisville School of Medicine, 530 S. Jackson St, Louisville, KY 40202, USA
| | - Jason D Fraser
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, USA
| | - Julia E Grabowski
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL 60611, USA
| | - Michael A Helmrath
- Department of Pediatric Surgery, Cincinnati Children's Hospital, 3333 Burnet Ave, ML 2023, Cincinnati, OH 45229, USA
| | - Rashmi D Kabre
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL 60611, USA
| | - Jonathan E Kohler
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792, USA
| | - Matthew P Landman
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Emerson Hall, Indianapolis, IN 46202, USA
| | - Amy E Lawrence
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43206, USA
| | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792, USA
| | - Grace Z Mak
- The University of Chicago Medicine, Comer Children's Hospital, Chicago, IL, USA
| | - Elissa Port
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL 60611, USA
| | - Jacqueline Saito
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, Suite 5S40-Campus Box 8235, One Children's Place, St. Louis, MO 63110, USA
| | - Jared Silverberg
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Mark B Slidell
- The University of Chicago Medicine, Comer Children's Hospital, Chicago, IL, USA
| | - Tiffany N Wright
- Department of Surgery, Division of Pediatric Surgery, University of Louisville School of Medicine, 530 S. Jackson St, Louisville, KY 40202, USA
| | - Dave R Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 N 92nd St, Suite 320, Milwaukee, WI 53226, USA
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16
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Zheng C, Lin Y, He Y, Shen Y, Fan J, Fang Y. Exploration of the thoracoscopic treatment of esophageal atresia under high-frequency ventilation. Front Pediatr 2022; 10:1066492. [PMID: 37077751 PMCID: PMC10107367 DOI: 10.3389/fped.2022.1066492] [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] [Received: 10/10/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
ObjectiveExplore the feasibility and safety of thoracoscopy in the treatment of esophageal atresia under high-frequency oscillatory ventilation (HFOV) mode.MethodsThis was a single-center retrospective analysis. A total of 24 children were divided into the HFOV and the No-HFOV group. The demographic information, surgical results and relevant experience were analyzed.ResultsAll patients in the HFOV group underwent thoracoscopic esophageal atreplasty with a mean operation duration of 165.8 ± 33.9 min. Two patients had postoperative anastomotic leakage, which was cured after conservative treatment. One child had a recurrent tracheoesophageal fistula, which was closed after endoscopic cauterization. The mean postoperative mechanical ventilation time was 8.83 ± 8.02 days. There was no return of anastomotic leakage or r-TEF after oral feeding. Furthermore, there was no significant difference between the NO-HFOV and the HFOV groups except for the operation time where the HFOV group was shorter than that of the NO-HFOV group.ConclusionThoracoscopic esophageal atresia anastomosis under HFOV ventilation is feasible for patients with severe pulmonary infection, heart malformation, such as patent ductus arteriosus, ventricular septal defect, and poor anesthesia tolerance, but the long-term prognosis still needs further study in a large sample size.
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Affiliation(s)
- Chao Zheng
- Department of Pediatric Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), Fuzhou, China
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yu Lin
- Department of Pediatric Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), Fuzhou, China
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Correspondence: YiFan Fang
| | - Yuanbin He
- Department of Pediatric Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), Fuzhou, China
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yong Shen
- Department of Pediatric Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), Fuzhou, China
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Jiansen Fan
- Department of Pediatric Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), Fuzhou, China
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yifan Fang
- Department of Pediatric Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), Fuzhou, China
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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17
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Galazka P, Skinder D, Styczynski J. Short-term and mid-term effects of thoracoscopic repair of esophageal atresia: No anastomotic leaks or conversions to open technique. Front Surg 2022; 9:1009448. [PMID: 36504576 PMCID: PMC9727094 DOI: 10.3389/fsurg.2022.1009448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
The frequency rate of esophageal anastomosis leaks after thoracoscopic correction of esophageal atresia (EA) in the current literature is reported as 5.6%-24.7% and a conversion rate of 2%-53%. The objective of this retrospective study was to examine the characteristics of EA and analysis of the safety and efficacy of EA repair with the use of the thoracoscopic approach in a single academic center, as well as risk factors analysis in the context of short-term and mid-term follow-up status. A retrospective analysis of the management of all consecutive newborns affected by EA hospitalized in our department over a period between 2013 and 2022, including preoperative, perioperative, and postoperative management, together with the outcome, complications and long-term follow-up status was performed. A total of 38 patients with a median birth weight of 2,570 g (range; 1,020-3,880) were treated over the study period, including 30/38 (78.9%) with additional congenital anomalies. Overall, 30 patients underwent primary anastomosis of the esophagus and eight underwent a multistaged procedure, with or without an initial ligation of the tracheoesophageal fistula and delayed primary anastomosis. Overall survival for all patients was 0.894 ± 0.050, with a median follow-up of 4.5 years. We noted neither anastomotic leaks nor conversions to open technique in our cohort. Implementation of vancomycin prophylaxis was successful in preventing postoperative central venous access-related infectious complications. At the end of the follow-up, 85% of patients have a Lansky performance score ≥80. Risk factors analysis for length of hospitalization, overall survival, Lansky performance status, and neurological impairment were analyzed. In conclusion, we have found that the outcome of thoracoscopic repair of EA in terms of surgery-dependent morbidity (anastomosis leakage, conversion rate to open surgery), provides benefit to those previously reported in the literature, regardless of the prognostic criteria of the classification system.
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Affiliation(s)
- Przemyslaw Galazka
- Department of General and Oncologic Surgery for Children and Adolescents, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland,Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland,Correspondence: Przemysław Galazka
| | - Dominika Skinder
- Department of General and Oncologic Surgery for Children and Adolescents, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland
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Musculoskeletal deformities in children with congenital thoracic malformations: a population-based cohort study. Pediatr Surg Int 2022; 38:731-736. [PMID: 35235016 DOI: 10.1007/s00383-022-05101-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE It is unclear if musculoskeletal deformities observed in patients with congenital diaphragmatic hernia (CDH), congenital lung lesion (CLL) and esophageal atresia/tracheoesophageal fistula (EA/TEF) are associated with the anomaly or are a result of the surgery required to treat the anomaly. This study compared the prevalence of musculoskeletal deformities for: (1) children with congenital thoracic anomalies to controls; (2) CLL to EA/TEF both repaired via thoracotomy; and (3) CLL and EA/TEF to CDH repaired via laparotomy. METHODS We performed a retrospective study of children with CLL, CDH or EA/TEF between 1990 and 2016. Date-of-birth-matched control groups were generated from a population-based dataset. International Classification of Disease codes were used to identify scoliosis and pectus anomalies. We determined Hazard ratios (HR) for cases versus controls. RESULTS We included 167 cases (CDH n = 82; CLL n = 29; EA/TEF n = 56) and 1670 controls. EA/TEF had a greater risk of scoliosis (HR 5.52, 95%CI 1.49,13.73) and pectus deformities (HR 4.07, 95%CI 1.96,8.45). CDH showed more scoliosis (HR 5.03, 95%CI 1.99,12.74) but not pectus anomalies. Musculoskeletal deformities were not more common in CLL. CONCLUSION Children born with CDH or EA/TEF, but not CLL, had more musculoskeletal deformities than controls. The inconsistent association between musculoskeletal deformities and the surgical approach suggested a congenital predisposition.
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Zhao J, Yang S, Li S, Wang P, Zhang Y, Zhao Y, Hua K, Gu Y, Liao J, Li S, Chen Y, Huang J. Retrospective analysis of pneumothorax after repair of esophageal atresia/tracheoesophageal fistula. BMC Pediatr 2021; 21:543. [PMID: 34861834 PMCID: PMC8641193 DOI: 10.1186/s12887-021-02948-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background To analyze the possible causes, treatment and outcomes of postoperative pneumothorax in patients with Gross type C esophageal atresia/tracheoesophageal fistula (EA/TEF). Methods Medical records of patients with Gross type C EA/TEF who were diagnosed and treated in Beijing Children’s Hospital from January 2007 to January 2020 were retrospectively collected. They were divided into 2 groups according to whether postoperative pneumothorax occurred. Univariate and multivariate logistic regression analysis were performed to identify risk factors for pneumothorax. Results A total of 188 patients were included, including 85 (45 %) in the pneumothorax group and 103 (55 %) in the non-pneumothorax group. Multivariate logistic regression analysis showed that postoperative anastomotic leakage [P < 0.001, OR 3.516 (1.859, 6.648)] and mechanical ventilation [P = 0.012, OR 2.399 (1.210, 4.758)] were independent risk factors for pneumothorax after EA/TEF repair. Further analysis of main parameters of mechanical ventilation after surgery showed that none of them were clearly related to the occurrence of pneumothorax. Among the 85 patients with pneumothorax, 33 gave up after surgery and 52 received further treatment [conservative observation (n = 20), pleural puncture (n = 11), pleural closed drainage (n = 9), both pleural puncture and closed drainage (n = 12)]. All of the 52 patients were cured of pneumothorax at discharge. Conclusions Anastomotic leakage and postoperative mechanical ventilation were risk factors for pneumothorax after repair of Gross type C EA/TEF, but the main parameters of mechanical ventilation had no clear correlation with pneumothorax. After symptomatic treatment, the prognosis of pneumothorax was good. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02948-x.
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Affiliation(s)
- Jiawei Zhao
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Shen Yang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Siqi Li
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Peize Wang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Yanan Zhang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Yong Zhao
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Kaiyun Hua
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Yichao Gu
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Junmin Liao
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Shuangshuang Li
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Yongwei Chen
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Jinshi Huang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China.
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20
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Association of operative approach with outcomes in neonates with esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2021; 56:2172-2179. [PMID: 33994203 DOI: 10.1016/j.jpedsurg.2021.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/17/2021] [Accepted: 04/05/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE We sought to evaluate the impact of thoracoscopic repair on perioperative outcomes in infants with esophageal atresia and tracheoesophageal fistula (EA/TEF). METHODS The American College of Surgeons National Surgical Quality Improvement Program pediatric database from 2014 to 2018 was queried for all neonates who underwent operative repair of EA/TEF. Operative approach based on intention to treat was correlated with perioperative outcomes, including 30-day postoperative adverse events, in logistic regression models. RESULTS Among 855 neonates, initial thoracoscopic repair was performed in 133 (15.6%) cases. Seventy (53%) of these cases were converted to open. Those who underwent thoracoscopic repair were more likely to be full-term (p = 0.03) when compared to those in the open repair group. There were no significant differences in perioperative outcome measures based on surgical approach except for operative time (thoracoscopic: 217 min vs. open: 180 min, p<0.001). A major cardiac comorbidity (OR 1.6, 95% CI 1.2-2.1; p = 0.003) and preoperative ventilator requirement (OR 1.4, 95% CI 1.0-1.9; p = 0.034) were the only risk factors associated with adverse events. CONCLUSIONS Thoracoscopic neonatal repair of EA/TEF continues to be used sparingly, is associated with high conversion rates, and has similar perioperative outcomes when compared to open repair. LEVEL OF EVIDENCE III.
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21
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Bisson B, Gottrand L, Aumar M, Nicolas A, Sfeir R, Labreuche J, Thevenon A, Gottrand F. Prevalence of and Risk Factors for Sagittal Posture Abnormalities in Children Born With Esophageal Atresia: A Prospective Cohort Study. Front Pediatr 2021; 9:762078. [PMID: 34900868 PMCID: PMC8656431 DOI: 10.3389/fped.2021.762078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Scoliosis is a well-described complication of esophageal atresia (EA) caused by the associated spine malformations and/or thoracotomy. However, the sagittal posture abnormalities in patients with EA have not been described. The aim of this study was to evaluate the prevalence of and risk factors for sagittal posture abnormalities at the age of 6 years in patients operated on for EA. Methods: A prospective cohort of 123 patients with EA was examined by the same rehabilitation doctor at the time of a multidisciplinary visit scheduled at the age of 6 years. Children presenting with scoliosis (n = 4) or who missed the consultation (n = 33) were excluded. Univariate and multivariate logistic regression models with Firth's penalized-likelihood approach were used to identify risk factors associated with sagittal posture anomalies. Candidate risk factors included neonatal characteristics, associated malformations, atresia type, postoperative complications, psychomotor development retardation, orthopedic abnormalities, and neurological hypotonia. Results: The prevalence rates of sagittal posture abnormalities were 25.6% (n = 22; 95% CI, 16.7-36.1%). Multivariate analysis showed that minor orthopedic abnormalities (OR: 4.02, 95% CI: 1.29-13.43, P = 0.021), and VACTERL (OR: 3.35, 95% CI: 1.09-10.71, P = 0.042) were significant risk factors for sagittal posture abnormalities. Conclusion: This study shows that sagittal posture anomalies occur frequently in children operated on at birth for EA and are not directly linked to the surgical repair. These children should be screened and treated using postural physiotherapy, especially those with VACTERL and minor orthopedic abnormalities.
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Affiliation(s)
| | - Laurence Gottrand
- IEM Dabbadie, APF France Handicap, Villeneuve d'Ascq, France.,Univ. Lille, CHU Lille, Reference Centre for Chronic and Malformative Esophageal Diseases (CRACMO), Inserm U1286, Lille, France
| | - Madeleine Aumar
- Univ. Lille, CHU Lille, Reference Centre for Chronic and Malformative Esophageal Diseases (CRACMO), Inserm U1286, Lille, France
| | - Audrey Nicolas
- Univ. Lille, CHU Lille, Reference Centre for Chronic and Malformative Esophageal Diseases (CRACMO), Inserm U1286, Lille, France
| | - Rony Sfeir
- Univ. Lille, CHU Lille, Reference Centre for Chronic and Malformative Esophageal Diseases (CRACMO), Inserm U1286, Lille, France
| | - Julien Labreuche
- Univ. Lille, CHU Lille, ULR 2694-METRICS, Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | | | - Frederic Gottrand
- Univ. Lille, CHU Lille, Reference Centre for Chronic and Malformative Esophageal Diseases (CRACMO), Inserm U1286, Lille, France
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