Categorization and repair of recurrent and acquired tracheoesophageal fistulae occurring after esophageal atresia repair

Smithers, C. Jason; Hamilton, Thomas E.; Manfredi, Michael A.; Rhein, Lawrence; Ngo, Peter; Gallagher, Dorothy; Foker, John E.; Jennings, Russell W.

doi:10.1016/j.jpedsurg.2016.08.012

Cited by 69 publications

(100 citation statements)

References 23 publications

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“…[1][2][3] Although many stric-tures can successfully be treated by esophageal dilatation, some are refractory to conservative treatment and subsequently require segmental resection of the stenosis or even esophageal replacement. 26 Pediatric esophageal surgery involving segmental resection and reanastomosis in esophagi without connatally impaired blood supply is also relevant for recurrent or acquired tracheoesophageal fistula in older children 27 and even ultimately severe reflux-induced esophageal strictures in adolescents. 28 Nevertheless, the information obtained from our model is suitable for these clinical cases, because our results indicate that the extent of resection does not influence the blood flow at the suture line.…”

Section: Discussionmentioning

confidence: 99%

Esophageal Blood Flow May Not Be Directly Influenced by Anastomotic Tension: An Exploratory Laser Doppler Study in Swine

et al. 2019

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Background Anastomotic tension has been linked to leakage and stenosis in esophageal surgery in both adults and children. We aimed to determine the effects of esophageal topography, operative technique, and anastomotic tension on esophageal blood flow. Materials and Methods We divided and reanastomosed the esophagi at the carinal level with increasing levels of anastomotic tension in piglets (n = 10) and sham controls (n = 4). We examined esophageal blood flow pre- and postoperatively using laser Doppler flowmetry at the anastomosis and two predetermined proximal and distal points. Blood flow in relation to distance from the anastomosis was examined by multivariate linear regression. Results Thoracotomy alone did not influence perfusion at the carinal level in shams (Δ = 3.13 laser Doppler units, 95% confidence interval: −3.4 to 9.7, p = 0.2686). We constructed a (F[5,134] = 6.34, p < 0.0001) multinomial regression model based on distance to the anastomotic site and pre-/postoperative measurements (adjusted R 2 = 0.1624). Tissue blood flow was higher distant to the carina, but lower postoperatively and not influenced by the tension resulting from the extent of resection (F[1, 8] = 1.134, p = 0.318). Conclusion Esophageal blood flow is higher at greater distances to the carinal level and hampered by esophageal division and reanastomosis. The extent of resection has less influence than previously assumed. Therefore, leakage and stenosis after esophageal anastomosis may not solely be caused by insufficient anastomotic blood flow.

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Section: Discussionmentioning

confidence: 99%

Esophageal Blood Flow May Not Be Directly Influenced by Anastomotic Tension: An Exploratory Laser Doppler Study in Swine

et al. 2019

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“…In those cases, we have, therefore, opted to perform the repair on CPB through a midline sternotomy as opposed to conventional thoracotomy [12]. Provenzano et al [13] report utilising CPB in patients with distal TOF for which they favour a slide tracheoplasty repair, but do not describe in detail their decision-making process for this.…”

Section: Discussionmentioning

confidence: 99%

The multi-disciplinary management of complex congenital and acquired tracheo-oesophageal fistulae

et al. 2018

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Aim of the studyComplex tracheo-oesophageal fistulae (TOF) are rare congenital or acquired conditions in children. We discuss here a multidisciplinary (MDT) approach adopted over the past 5 years.MethodsWe retrospectively collected data on all patients with recurrent or acquired TOF managed at a single institution. All cases were investigated with neck and thorax CT scan. Other investigations included flexible bronchoscopy and bronchogram (B&B), microlaryngobronchoscopy (MLB) and oesophagoscopy. All cases were subsequently discussed in an MDT meeting on an emergent basis if necessary.Main results14 patients were referred during this study period of which half had a congenital aetiology and the other half were acquired. The latter included button battery ingestions (5/7) and iatrogenic injuries during oesophageal atresia (OA) repair. Surgical repair was performed on cardiac bypass in 3/7 cases of recurrent congenital fistulae and all cases of acquired fistulae. Post-operatively, 9/14 (64%) patients suffered complications including anastomotic leak (1), bilateral vocal cord paresis (1), further recurrence (1), and mortality (1). Ten patients continue to receive surgical input encompassing tracheal/oesophageal stents and dilatations.ConclusionsMDT approach to complex cases is becoming increasingly common across all specialties and is important in making decisions in these difficult cases. The benefits include shared experience of rare cases and full access to multidisciplinary expertise.

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“…49 The diagnosis of recurrent or missed TEFs is often elusive to the unsuspecting physician and, in fact, it can be delayed by several months. 48,50 Typically, their clinical presentation includes persistent coughing (as a result of saliva aspiration), choking during feed, recurrent pneumonia, and ultimately chronic lung disease. They may also be responsible for brief resolved unexplained events (formerly known as apparent life-threatening events).…”

Section: Missed/recurrent Tracheoesophageal Fistulamentioning

confidence: 99%

“…After clinical suspicion is raised, diagnosis of a recurrent or missed TEF is confirmed by tracheobronchoscopy (in some complex cases aided by esophagoscopy and simultaneous instillation of methylene blue), preceded (or not) by contrast swallow in the prone position. A relevant moment during definition of a second TEF is the differential diagnosis between recurrent TEF, postoperative acquired TEF, and missed congenital TEF, as recently highlighted by Smithers et al 50 Importantly, the operation for either recurrent or acquired TEF is more difficult than surgery for a congenital missed TEF: postoperative adhesions and scarring increase the operative risks. As a consequence, the expected failure rate of a redo operation is higher than the accepted recurrence rate for congenital TEF.…”

Section: Missed/recurrent Tracheoesophageal Fistulamentioning

confidence: 99%

Perioperative Complications of Esophageal Atresia

2018

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Current survival rate of infants with esophageal atresia with/without tracheoesophageal fistula (EA/TEF) exceeds 90% and great interest is dedicated to the long-term outcomes and complications. However, perioperative complications represent a significant burden to the EA/TEF infants and a technical challenge for the surgeon. In this review, we will focus on the most frequent perioperative complications specific of EA/TEF to describe their predisposing factors, possible preventive measures, and treatment options.

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Categorization and repair of recurrent and acquired tracheoesophageal fistulae occurring after esophageal atresia repair

Cited by 69 publications

References 23 publications

Esophageal Blood Flow May Not Be Directly Influenced by Anastomotic Tension: An Exploratory Laser Doppler Study in Swine

Esophageal Blood Flow May Not Be Directly Influenced by Anastomotic Tension: An Exploratory Laser Doppler Study in Swine

The multi-disciplinary management of complex congenital and acquired tracheo-oesophageal fistulae

Perioperative Complications of Esophageal Atresia

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