Delayed primary reconstruction of esophageal atresia and distal tracheoesophageal fistula in a 471-g infant

Ito, Keiichi; Ashizuka, Shuichi; Kurobe, Masashi; Ohashi, Shinsuke; Kuwashima, Naruo; Yoshizawa, Joji; Ohki, Takao

doi:10.1016/j.ijscr.2012.11.010

Cited by 7 publications

(6 citation statements)

References 7 publications

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“…Since then, several studies advocating either primary or staged repair with different conclusions have been published [ (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25); Table 3]. These studies are solitarily retrospective single-center analyses with a maximum of 25 patients.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Patients With Esophageal Atresia and Very Low Birth Weight (≤ 1,500 g)

Ritz

Widenmann-Grolig²,

Jechalke³

et al. 2020

Front. Pediatr.

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Introduction: Primary repair of esophageal atresia (EA) in infants with very low birth weight (VLBW) and extremely low birth weight (ELBW) has been widely performed in pediatric surgery. However, several studies have shown that complication rates in infants with VLBW are high. We hypothesize preterm children benefit from a shorter, less-traumatizing operation in the first days of life, as staged repair implies. Methods: Patients with EA and VLBW were retrieved from the database of a large national patient organization KEKS e.V. Structured questionnaires were sent to all the patients' families; the responses were pseudonymized and sent to our institution. Results: Forty-eight questionnaires from patients were analyzed. The mean birth weight was 1,223 g (720–1,500 g). Primary repair was performed in 25 patients (52%). Anastomotic insufficiency (AI) was reported in 9 patients (19%), recurrent fistula (RF) in 8 (17%), and anastomotic stenosis in 24 patients (50%). Although AI was almost twice as common after primary repair than after staged repair (24 vs. 13%; p = 0.5), the difference was not statistically significant. RF was more frequent after primary repair (28 vs. 4%; p = 0.04), gastroesophageal reflux was more frequent in the group after staged repair (78 vs. 52%; p = 0.04), and both correlations were statistically significant. Intracranial hemorrhage (ICH) was reported in 11 patients (23%) and was observed in 7 of them (64%, p = 0.4) after primary repair. ICH was reported in 60% of patients with ELBW and 75% of patients when ELBW was paired with primary repair. Conclusion: This study demonstrates the complication rate in patients with VLBW is higher than the average of that in patients with EA. The study indicates that a staged approach may be an option in this specific patient group, as less RF and AI are seen after staged repair. ICH rate in patients with ELBW seemed to be especially lower after staged repair. Interestingly, gastroesophageal reflux was statistically significantly higher in the group after staged repair, and postoperative ventilation time was longer. It is therefore necessary to individually consider which surgical approach is appropriate for this special patient group.

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Section: Discussionmentioning

confidence: 99%

Outcome of Patients With Esophageal Atresia and Very Low Birth Weight (≤ 1,500 g)

Ritz

Widenmann-Grolig²,

Jechalke³

et al. 2020

Front. Pediatr.

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“…сообщили об успешном лечении новорожденных весом 500 и 470 г, выполнив этапную коррекцию атрезии пищевода [5,6]. Hannon E. J. et al сообщают о лечении 9 пациентов весом менее 1000 г [6,7]. Общая летальность составила 56%.…”

Section: Discussionunclassified

Treatment of Patients Low Weight With Esophagus Atresia

Razumovskiy

Разумовский²,

Mokrushina

et al. 2019

jour

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Introduction. Surgical treatment of intestinal atresia with distal tracheoesophageal fistula involves resection of fistula and intestinal primary anastomosis. However, premature children often have complications associated with delayed anastomosis. Thus, an optimal surgical approach is not determined. Purpose. Analyzing treatment results in newborns with intestinal atresia and very low weight. Materials and methods. Treatments outcomes in infants with intestinal atresia and very low weight (less than 1500 g) from 2008 to 2017 were assessed retrospectively. The patients were divided into 2 groups: (1) fistula dressing and crossing with subsequent delayed anastomosis reconstruction and (2) primary anastomosis. Demographic, surgical and postoperative complications were compared. Results. 23 preterm children with IA/TEF were operated. Twelve patients (52%) underwent primary anastomosis, whereas 11 (48%) of them had a stepwise surgery. Anastomotic leak confirmed by esophagram was similar in both groups (17% and 18%). Stenosis was more common in step-wise surgery (83%) as compared to the group of primary anastomosis (27%) (р<0.05). The esophagus was preserved in two patients who underwent step-wise surgery. 4 patients had coloesophagoplasty. The postoperative period was similar in both groups. 6 patients (50%) from the step-wise group and 5 patients (45%) from the group of primary anastomosis died. Conclusion. Staging plasty of IA/TEF in newborns does not improve the quality of life. In this group, gastro- and esophagostomy exteriorization is a preferable surgical approach.

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“…[10] сообщают, что этапное лечение АП у младенцев с массой тела при рождении менее 1500 г способствовало возникновению меньшего количества осложнений в зоне анастомоза и уменьшению показателя смертности [10]. Таким образом, препятствиями к выполнению первичного анастомоза, по мнению многих авторов, являются большой диастаз между сегментами пищевода, сопутствующие аномалии развития и очень низкая масса тела при рождении [4][5][6][7][8][9][10][11][12][13][14]. В таких ситуациях показано выполнение отсроченного эзофаго-эзофагоанастомоза или замена пищевода толстой кишкой или желудком.…”

Section: Discussionunclassified

“…При этом пороке развития операцией выбора является выполнение первичного анастомоза пищевода. Однако, по мнению многих авторов, большой диастаз между сегментами пищевода, сопутствующие аномалии и масса тела менее 1500 г служат препятствиями к наложению первичного анастомоза [4][5][6][7][8][9][10][11][12][13][14]. В подобных ситуациях показано выполнение отсроченного эзофаго-эзофагоанастомоза или замена пищевода толстой кишкой или желудком.…”

Section: Introductionunclassified

Complications and long-term results of delayed esophagoezophagostomy for esophageal atresia

Razumovsky

Alkhasov

Mokrushina

et al. 2017

Khir. Z. im. N.I. Pirogova

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Delayed primary reconstruction of esophageal atresia and distal tracheoesophageal fistula in a 471-g infant

Abstract: In the present case, ligation of the tracheoesophageal fistula and esophageal reconstruction should have been performed as soon as possible.

Cited by 7 publications

References 7 publications

Outcome of Patients With Esophageal Atresia and Very Low Birth Weight (≤ 1,500 g)

Outcome of Patients With Esophageal Atresia and Very Low Birth Weight (≤ 1,500 g)

Treatment of Patients Low Weight With Esophagus Atresia

Complications and long-term results of delayed esophagoezophagostomy for esophageal atresia

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