Esophageal atresia: Primary results of 500 consecutively treated patients

Louhimo, I; Lindahl, Harry

doi:10.1016/s0022-3468(83)80089-x

Cited by 211 publications

(89 citation statements)

References 21 publications

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“…In only one study (21) was the calculated prevalence of neural crest-related CVA much lower (36%) than that found in the present series of patients. The explanation for this discrepancy is that minor abnormalities, such as persistent left superior vena cava or aberrant subclavian artery or right aortic arch, were not listed and were therefore probably included in the group of "others."…”

contrasting

confidence: 91%

Pattern of Cardiovascular Anomalies Associated with Esophageal Atresia: Support for a Caudal Pharyngeal Arch Neurocristopathy

et al. 2001

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Patients with cephalic neurocristopathy (an abnormality of neural crest differentiation) present a striking pattern of associated cardiovascular anomalies (CVA). Therefore, to support the hypothesis that esophageal atresia (EA) may be related to a defective contribution from the cephalic neural crest, we studied the pattern of CVA associated with EA. Medical records of 99 patients with isolated EA, 101 with isolated anorectal malformations (ARM) and 15 with both EA and ARM, consecutively admitted to our unit, were reviewed. The prevalence and pattern of CVA associated with isolated EA or isolated ARM were compared on the assumption that the cranial or caudal location of a major malformation is related to a different regional patterning of associated anomalies. The prevalence of CVA was 39% in patients with isolated EA and 7% in those with isolated ARM (p Ͻ 0.01). Neural crest-related CVA (aortic arch anomalies, conotruncal defects, and superior vena cava malformations) accounted for 72% of all CVA in patients with isolated EA versus 14% in those with isolated ARM (p Ͻ 0.02). In patients with isolated EA, anomalies of the fourth and sixth aortic arch derivatives accounted for 75% of all neural crest related CVA. The present pattern of CVA in infants with EA supports the concept that EA may be related to an abnormal contribution from caudal portion of cephalic neural crest. Nearly all infants with EA present with clinical manifestations of a maturational dysautonomia (1). The autonomic disturbances are similar to those found in infants with PierreRobin or Di George syndromes, which are considered pharyngeal arch syndromes related to a cephalic neurocristopathy (an abnormality of cephalic neural crest differentiation) (2). In addition, Ͼ90% of patients with EA present with one or more minor facial anomalies, which are considered markers of an abnormal developmental activity of the cephalic neural crest (3). These findings, i.e. the association with maturational dysautonomia and facial anomalies, suggest that EA should be included among the pharyngeal arch neurocristopathies (3).To test this hypothesis, we studied, in a large series of patients with EA, the prevalence of aortic arch and conotruncal heart anomalies, which are considered the most distinctive CVA of Di George syndrome (4 -6). These defects appear to be related to an abnormal participation of the cephalic neural crest, inasmuch as ablation of cardiac neural crest, in chick embryos, invariably results in aortico-pulmonary septation defects associated with anomalies of the great arteries (7-10). METHODSThe records of 114 patients with EA and 116 with ARM, consecutively admitted to our unit between 1967 and 1998, were retrospectively reviewed. We decided to compare the prevalence and the pattern of CVA associated with EA with those associated with ARM, on the assumption that these two abnormalities should have a different pattern of associated anomalies. Actually, abnormal development of the cephalic neural crest may result in face, thymus, thyroid, parath...

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contrasting

confidence: 91%

Pattern of Cardiovascular Anomalies Associated with Esophageal Atresia: Support for a Caudal Pharyngeal Arch Neurocristopathy

et al. 2001

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“…Singh et al reported suturing an upper flap pouch to the spatulated end of the lower pouch [9]. The basic idea of all the above methods was to avoid anastomotic site narrowing [9,20,21].…”

Section: Discussionmentioning

confidence: 99%

http://medcraveonline.com/JPNC/JPNC-06-00234.php

Ghosh¹

2017

JPNC

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Purpose: Tracheo esophageal fistula repair are usually complicated by the development of anastomotic leaks and strictures. The technique of anastomosis has long been a matter of debate. The most common method has been transverse circular esophageal anastomosis. We aim to bring down the frequency of early complications associated with conventional technique of esophageal repair by introduction of a modified repair method.Methods: Twenty patients of congenital tracheo esophageal fistula underwent modified oblique esophago esophageal anastomosis with pleural patch. The patients were followed up for immediate complications of anastomotic leaks and strictures. Results: Contrast esophagogram showed no incidence of anastomotic leak and strictures in all the twenty patients. Conclusion:The oblique esophageal anastomois with pleural patch serves as a wide bore anastomosis compared to the classical circular anastomosis, hence explaining the reduced incidence of decreased leaks and strictures associated with this method.

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“…Since then over 200 cases have been reported in the literature. 4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] In this anomaly, the esophagus and trachea are quite normal, except that there is a very short fistula between the two, which runs from the esophagus upward to the trachea. Because of this upward course, swallowing is not always associated with aspiration into the trachea.…”

Section: Discussionmentioning

confidence: 99%

“…Because of this upward course, swallowing is not always associated with aspiration into the trachea. 21 These children usually will present with a clinical triad of paroxysms of coughing precipitated by feeding with occasional cyanosis during some feeds, gaseous distention of the gastrointestinal tract, and repeated attacks of pneumonia. It is known that some of these cases remain undiagnosed until adulthood, the oldest reported case being 63 years of age.…”

Section: Discussionmentioning

confidence: 99%