Endoscopic Detection and Surgical Repair of Congenital Tracheo-Esophageal-Fistula (TEF) ± Esophageal Atresia (EA)

Abstract

Purpose: This study was performed to evaluate the management of tracheoesophageal fistula (TEF) ± esophageal atresia (EA) under the guidance of preoperative tracheo-bronchoscopy (TrSc). Methods: Between 2007 and July 2014, a total of 26 consecutive newborns who underwent rigid TrSc for suspected TEF were identified. All associated charts and operation reports were retrospectively analyzed. Results: Distal TEF with EA (Gross C) predominated (n = 18). Furthermore, we managed 2 infants with proximal and distal TEF (Gross D) and 4 infants with isolated TEF (Gross E). In our hands, TrSc was feasible in infants with a birth weight above 1300 g. Twenty-five fistulas were identified by endoscopy in 23 patients. In one infant with a birth weight below 1000 g, an attempt to perform TrSc was interrupted, and urgent TEF closure was required. Fistula site at the carina was associated with a high rate of esophageal anastomosis under tension. During surgery, proximal TEF and isolated TEF were safely approached via right cervicotomy (n = 5). Conclusion: This study supports the routine use of rigid TrSc at the time of surgery. Rigid TrSc allowed the surgical team to identify the number and location of TEFs, and the incidence of side effects was low.

Review. Gastrointestinal Surgery in Neonates: Practice, Facts, and Trends

“…Fetuses with EA without TEF are diagnosed prenatally more often than those with the classic form of EA. Preoperative tracheobronchoscopy increases the safety of the procedure by ruling out unusual variants of the TEF (presence of a proximal fistula, presence of H-fistula) and laryngotracheal fissure [51].…”

Options for Closure of Retro-Duodenal Perforation After Endoscopic Papillosphincterotomy With a Self-Expending Stent

“…Однако изобретение саморасширяющихся эндопротезов не ограничивает горизонты клиниче-ской применимости стентирования дренирующей и каркасной функцией -покрытые саморасширя-ющиеся стенты способны закрывать перфорации и дефекты оболочечно-слоистых органов -подоб-ные возможности уже давно используются при эн-доскопическом лечении трахеопищеводных сви-щей [4]. Очевидно, что при раскрытии саморасши-ряющегося эндопротеза происходит компресcия рядом лежащих тканей [5], что давно использует-ся для сдавления микроциркуляторного русла, на-пример при гемобилии [6] и позволяет использо-вать данную технологию для закрытия дефектов и перфорационных каналов в этих тканях, однако данные возможности в настоящее время не ис-следованы.…”