Esophageal atresia is a congenital anomaly in which the oral end of the esophagus ends in a pouch. Its frequency is 1 in 2500-4500 newborns. Esophageal atresia is considered a complex malformation; the results of its treatment are used to judge the level of surgical care provided by the medical institution. With this malformation, the operation of choice is to perform a primary esophageal anastomosis. Primary anastomosis may be accompanied by severe early and late complications, such as anastomotic leakage, recurrent tracheo-esophageal fistula, esophageal stenosis, the development of reflux esophagitis, etc. However, according to many authors, large diastasis between the segments of the esophagus, concomitant anomalies and body weight less than 1,500 g are obstacles for primary anastomosis. In such situations, the implementation of a delayed esophageal anastomosis or replacement of the esophagus with a large intestine or stomach is recommended. Currently, with the introduction of thoracoscopically performed esophageal anastomosis in newborns, there is an improvement in the results of treatment with esophageal atresia. According to the authors, approximately 75 % of operations for esophageal atresia can be performed thoracoscopically with good results. Progress in thoracoscopic treatment of esophageal defect has significantly improved the quality of life of children after surgical correction of the anomaly.
Objective: The purpose of this study was to analyze the structure of morbidity and the results of treatment of children with EA in the Far Eastern Federal District.Methods: The retrospective analysis of the annual reports of pediatric surgeons of all 11 regions of the Far Eastern Federal District. Total 46 children with EA were born from 2019 to 2021, 1 child died because of severe comorbidity before surgery, 1 was operated in Moscow. 44 children having A, B, C, D types of EA by Gross were treated by regional surgeons.Results: 64% of children were boys and 36% - girls, half of the children were born prematurely, every fourth was fed before getting diagnosis. The most common form was EA with lower tracheoesophageal fistula (93%). Combined malformations were found in 60% of cases, the most frequent was cardiac anomaly. Anastomosis was applied in 86% of operated, the rest underwent staged procedures. 81% are alive after applying anastomosis, 33% after coloesophageal replacement. Thoracoscopic AP treatment is widely used in regions having much higher population density than the Far East, but there is a tendency to improve this indicator. As for our district, there are several ways to improve surgical care: concentration of patients of the same profile in one or two regional centers or involvement of leading Russian specialists in providing high-tech medical care.Conclusions: The peculiarities of the logistics of the region lead to the idea of creating a single Far Eastern multidisciplinary surgical center providing counseling, transportation, diagnostics and treatment of patients with congenital malformations at the modern level.
Despite significant advances in the treatment of congenital malformations in newborns, there is still a fairly high mortality rate in the group of newborns with congenital diaphragmatic hernia. This fact is associated with the high incidence of concomitant pulmonary hypertension in newborns with lung hypoplasia due to compression by organs that have invaded the chest cavity [1]. In the early 2000s, the mortality rate in congenital diaphragmatic hernia in newborns was approximately 30%. With the introduction of delayed surgery tactics in recent years, survival has improved in the group of infants with hypertension in the pulmonary circulation. The main decisive moments for stabilizing a newborn with congenital diaphragmatic hernia and reducing the degree of pulmonary hypertension are the early transfer of the patient to machine breathing in high-frequency ventilation mode, adherence to the temperature regime, minimization of invasive procedures, and the inclusion of nitric oxide in the breathing mixture as a respiratory vasodilator. The incidence of diaphragmatic hernias varies widelyfrom 1 in 2000 to 1 in 4000 newborns; this does not take into account a large group of stillborns with diaphragm malformations [2].
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