Current Controversies in the Surgical Treatment of Esophageal Atresia

Abstract

Background and Aims: esophageal atresia (ea) with or without tracheo-esophageal fistula (tef) is a rare condition that can be nowadays succesfully treated. the current interest therefore is focused on the management of the difficult cases, on thoracoscopic approach, and on some aspects of the long-term results.Methods: the current strategies for the difficult or impossible anastomoses in pure and long-gap ea, the introduction of thoracoscopic repair and the causes, mechanisms and management of post-operative gastro-esophageal reflux (ger) are reviewed.Results: methods of esophageal elongation and multi-staged repair of pure and longgap ea allow anastomosis but with functional results that are often poor. esophageal replacement with colon or stomach achieves at least similar results and often requires less procedures. thoracoscopic repair is a promising adjunct, but the difficulties for setting it as a gold-standard are pointed out. ger is a part of the disease and its surgical treatment, that is often required, is burdened by high failure rates.Conclusions: ea with or without tef can be successfully treated in most cases, but a number of unsolved issues remain and the current approach to difficult cases will certainly evolve in the future.

Respiratory Care of Infants and Children with Congenital Tracheo-Oesophageal Fistula and Oesophageal Atresia

“…In these cases, surgical repair may be more complicated and may require a staged approach with multiple surgeries, and sometimes partial oesophageal replacement with colon or stomach. 48 A gastrostomy tube may need to be placed prior to surgical repair in order to support nutrition, particularly in cases when delayed or staged repair is required. Isolated TOF and some cases of OA/TOF may be candidates for thoracoscopic repair.…”

The Impact of Congenital Esophageal Atresia on the Family Functioning

“…tracheo-esophageal fistula (TEF) (Clark, 1999). All infants with EA need surgery during their first days of life, and primary surgery with esophageal anastomoses is preferable treatment (Śmigiel et al, 2015;Tovar & Fragoso, 2011). Although survival rates have improved up to 95%, EA is a cause of long-term esophageal and respiratory complications persisting into adulthood (Ijsselstijn, van Beelen, & Wijnen, 2013): dysphagia and gastroesophageal reflux disease (GOR) (Pedersen et al, 2013), feeding difficulties (Menzies, Hughes, Leach, Belessis, & Krishnan, 2017), chronic cough, wheezing, and recurrent airway infections (Porcaro et al, 2017).…”

Thoracotomy for repair of esophageal atresia: not as bad as they want you to think!

“…Tovar and Fragoso in their ‘Current Controversies in the Surgical Treatment of Esophageal Atresia’ paper in 2011 perhaps summarized it best: ‘… the gold standard remains a good anastomosis with survival, limited sequelae and good quality of life rather than a successful minimally invasive repair’ . Our currency of good surgical technique coupled with the best possible outcomes for our patients demands that we continue to search for newer and better ways to treat diseases like EA through practice, a spirit of enquiry, ethically conducted collaborative research, and acting in good conscience.…”