Lower esophageal banding in extremely low birth weight infants with esophageal atresia and tracheoesophageal fistula is a life saving practice followed by a successful delayed primary thoracoscopy reconstruction

Margain, Loren; Perez-Etchepare, Eduardo; Varlet, François; López, Manuel

doi:10.1016/j.jpedsurg.2014.10.055

Cited by 12 publications

(4 citation statements)

References 14 publications

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“…Margain et al. report on three cases with birth weights and gestational ages of 490, 790, and 800 g and 25, 26, and 27 weeks, respectively [ 15 ]. They were primary treated with lower esophageal banding, followed by delayed thoracoscopic esophageal repair and dissection of the fistula.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of esophageal atresia with lower tracheoesophageal fistula in an extremely preterm infant (510 g, 25 + 5 weeks): a case report

Thomé

Stepan

et al. 2021

J Med Case Reports

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Background The surgical management of esophageal atresia in extreme-low-birth-weight infants (< 1000 g) is challenging. We report on an extreme-low-birth-weight infant who was extremely preterm (510 g, 25 + 5 weeks) and of prenatally unknown Gross type C esophageal atresia. Case presentation After resuscitation and intubation, the tracheoesophageal fistula was closed on the first day of life in the neonatal intensive care unit via an extrapleural approach using a titanium clip. On the sixth day of life, the Caucasian child was extubated. To minimize the operative trauma in the initial neonatal period, we prolonged gastrostomy placement until the 22nd day of life (weight 725 g). At the age of 3 months (weight 2510 g), thoracoscopic esophageal anastomosis was performed. The postoperative course was unremarkable. During the further clinical course, eight esophageal dilations were necessary. Currently, the patient swallows without difficulties at the age of 4 years and thrives well [15 kg (Percentile 28); 100 cm (Percentile 24)]. Conclusions Our case shows that minimized postnatal surgical trauma with primary tracheoesophageal fistula closure at the bedside, delayed gastrostomy, and minimally invasive esophageal repair after substantial weight gain (> 2.5 kg) is a good strategy for esophageal atresia/tracheoesophageal fistula in extreme-low-birth-weight infants.

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Section: Discussionmentioning

confidence: 99%

Surgical treatment of esophageal atresia with lower tracheoesophageal fistula in an extremely preterm infant (510 g, 25 + 5 weeks): a case report

Thomé

Stepan

et al. 2021

J Med Case Reports

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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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“…Пациенты АП и TПС могут потребовать экстренного лигирования свища для достижения стабильности пациента. Но риск продления анестезии у потенциально нестабильного маленького ребенка и выполнение первичного анастомоза должен быть взвешен, чтобы исключить развитие фатального состояния [12,13,14].…”

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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Lower esophageal banding in extremely low birth weight infants with esophageal atresia and tracheoesophageal fistula is a life saving practice followed by a successful delayed primary thoracoscopy reconstruction

Cited by 12 publications

References 14 publications

Surgical treatment of esophageal atresia with lower tracheoesophageal fistula in an extremely preterm infant (510 g, 25 + 5 weeks): a case report

Surgical treatment of esophageal atresia with lower tracheoesophageal fistula in an extremely preterm infant (510 g, 25 + 5 weeks): a case report

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

Treatment of Patients Low Weight With Esophagus Atresia

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