Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula

Lal, Dave R.; Gadepalli, Samir K.; Downard, Cynthia D.; Ostlie, Daniel J.; Minneci, Peter C.; Swedler, Ruth M.; Chelius, Thomas; Cassidy, Laura D.; Rapp, Cooper T.; Deans, Katherine J.; Fallat, Mary E.; Finnell, S. Maria E.; Helmrath, Michael A.; Hirschl, Ronald B.; Kabre, Rashmi; Leys, Charles M.; Mak, Grace Z.; Raque, Jessica; Rescorla, Frederick J.; Saito, Jacqueline M.; Peter, Shawn D. St.; Allmen, Daniel von; Warner, Brad W.; Sato, Thomas T.

doi:10.1016/j.jpedsurg.2016.11.046

Cited by 154 publications

(149 citation statements)

References 32 publications

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“…There still is no general consensus on a preferred surgical technique (open vsthoracoscopic procedure) . The medical and surgical management of EA repair are decided in light of comorbidities, type of EA/TEF, experience of the surgeon, distance between the two ends of the esophagus, surgical and anesthesiologist preference and local hospital practice . Therefore, the perioperative anesthetic management of EA/TEF in the Erasmus MC‐Sophia Children's Hospital was not standardized, which caused a wide variation in care.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical repair of esophageal atresia (EA) is a challenging procedure which requires close collaboration between the surgical and anesthetic teams. Factors such as prematurity, low birth weight, respiratory problems, and associated morbidities, in particular cardiac anomalies, increase the complexity of the procedure . The presence of a tracheo‐esophageal fistula (TEF)—found in the majority of cases—carries the risk of insufflating the stomach, instigating high intra‐abdominal pressures, and impeding ventilation.…”

Section: Introductionmentioning

confidence: 99%

“…The asterisk (*) represents the sole intraoperative capillary blood gas analysis. All other measured blood gas values are from arterial blood gas samples [Colour figure can be viewed at wileyonlinelibrary.com] TEF, experience of the surgeon, distance between the two ends of the esophagus, surgical and anesthesiologist preference and local hospital practice 2,32. Therefore, the perioperative anesthetic management of EA/TEF in the Erasmus MC-Sophia Children's Hospital was not standardized, which caused a wide variation in care.Independent of the surgical technique used, periods of severe intraoperative acidosis, hypercapnia, hypocapnia, hyperoxia, and hypoxemia, mostly independent of hypo-and hypertension, occurred in the patients in this study.…”

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confidence: 99%

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Perioperative management of esophageal atresia/tracheo‐esophageal fistula: An analysis of data of 101 consecutive patients

Hoorn

Costerus

Lau

et al. 2019

Pediatric Anesthesia

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Background The perioperative management of esophageal atresia/tracheo‐esophageal fistula by open or thoracoscopic approach can be complicated by metabolic derangements. Little is known, however, about the severity of derangements of vital and metabolic parameters in the perioperative period. Aim The aim of this study is to describe the perioperative courses of vital and metabolic parameters in 101 consecutive neonates undergoing surgical repair of esophageal atresia type C. Method In a retrospective cohort study, we extracted all data from the electronic anesthetic and medical charts of patients who underwent esophageal atresia type C repair within 30 days of life (2007‐2017). We distinguished three types of surgery: primary open, primary thoracoscopic, and primary thoracoscopic surgery converted to open surgery. Descriptive analysis was applied. Results The charts of 117 patients were reviewed: data of 101 were included. The perioperative anesthetic management was not standardized; various methods and medications were used for anesthesia induction and maintenance. Intraoperative blood gas analysis data of 72 patients were available and showed derangements regardless of type of surgery. The median pH‐value decreased to 7.21 [IQR 7.14‐7.30] and a pH‐value below 7.20 was found in 29 patients; in four cases below 7.0, with the lowest value 6.83. The median PaCO2 reached an upper level of 7.5kPa [IQR 5.8‐9.2]; in 13 cases above 10.0kPa, with a peak value of 25.8kPa. These high PaCO2 levels fluctuated with lowest measured PaCO2 of median 5.6 [IQR 4.5‐6.6], with the lowest value 2.8kPa. The median PaO2 level reached an upper level of 16.9kPa [IQR 11.8‐25.7], in 22 cases above 20.0kPa, with a peak value of 50.0kPa. These high levels fluctuated with lowest measured PaO2 levels of median 8.3kPa [IQR 6.73‐10.5]; the lowest PaO2 value was 4.7 kPa. Conclusion Open and thoracoscopic correction of esophageal atresia were associated with periods of severe metabolic derangements. These events need to be taken into account for the evaluation of esophageal atresia (surgical) care and in evaluations of short‐ and long‐term outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Perioperative management of esophageal atresia/tracheo‐esophageal fistula: An analysis of data of 101 consecutive patients

Hoorn

Costerus

Lau

et al. 2019

Pediatric Anesthesia

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“…Esophageal stricture, anastomotic leakage, and recurrent TEF are well‐known complications after EA repair. Previous studies found the esophageal stricture rate to vary between 25% and 42%, the anastomotic leakage rate between 11% and 23%, and the recurrent TEF rate between 4% and 9% . In a recent meta‐analysis, a comparison of thoracoscopic and open approaches found that the thoracoscopic approach notably reduced the length of hospital stay and time to oral refeeding, but it was associated with a longer operative time.…”

Section: Discussionmentioning

confidence: 99%

“…Anastomotic dehiscence, esophageal stricture, and recurrent tracheoesophageal fistula (TEF) are among the most common complications after EA repair . These complications may have great relevance to the short‐ and long‐term outcomes of patients who have undergone EA …”

Section: Introductionmentioning

confidence: 99%

Thoracoscopic approach for complications after esophageal atresia repair: initial experience

Novillo

Castro

Lenz

et al. 2019

Asian J Endoscop Surgery

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Introduction Improvements in technology and health care have helped reduce morbidity and mortality in patients with esophageal atresia. However, postoperative complications such as dehiscences, strictures, and recurrent fistulas still occur in a large percentage of patients. Here, we present our initial experience using the thoracoscopic approach for complications after esophageal atresia repair. Methods We retrospectively analyzed the medical records of patients who developed complications after esophageal atresia repair and underwent thoracoscopic reoperation at two centers. Anastomotic leakage, anastomotic stricture, and recurrent tracheoesophageal fistula were assessed as complications after esophageal atresia repair. Results We reoperated on four patients (range of age 3 days ‐ 2 years) by thoracoscopy. Two patients who had undergone thoracoscopic atresia repair presented with anastomotic dehiscence. The anastomoses were thoracoscopically reconstructed without tension. One patient had undergone thoracoscopic atresia repair presented with esophageal stricture refractory to endoscopic dilatations. Thoracoscopic esophagoesophagostomy was performed in this 2‐year‐old patient. One patient who had undergone esophageal atresia repair and tracheoesophageal fistula closure by thoracotomy presented with a recurrent fistula at 1 year of age. The patient underwent thoracoscopic fistula closure with a 5‐mm endostapler. All patients remain asymptomatic after reoperation. Conclusions Reoperation after esophageal atresia repair is challenging and carries a relatively high risk of developing complications. Compared to conventional surgery, the thoracoscopic approach in experienced hands offers better visualization and more accurate dissection and drainage of the thoracic cavity. Therefore, we want to encourage the use of thoracoscopy in the treatment of complications after esophageal atresia repair.

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Impact of definitive surgery for esophageal atresia on long‐term outcomes in patients with trisomy 18

Tamaki,

Iwatani,

Ikuta

et al. 2024

American J of Med Genetics Pt A

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This study investigates the long‐term outcomes of palliative and definitive surgeries for esophageal atresia (EA) in patients with trisomy 18 syndrome. A retrospective study included 25 cases undergoing EA surgery at our center between 2008 and 2022. The Palliative group (n = 16) comprised 13 cases with esophageal banding and 3 with tracheoesophageal fistula (TEF) division. The Definitive group (n = 9) included 5 cases with primary repair and 4 with staged repair following TEF division. The patient characteristics exhibited no significant differences between the groups. In the Definitive group, 56% (5/9) were successfully weaned off mechanical ventilation, compared with none in the Palliative group (p = 0.002). Survival‐to‐discharge rates were 31% (5/16) in the Palliative group and 67% (6/9) in the Definitive group. Home ventilator management was required for all 5 cases that required ventilation in the Palliative group, whereas only 17% (1/6) in the Definitive group needed it. The Palliative group also required continuous oral suction for persistent saliva removal, with two cases undergoing laryngotracheal separation. Overall, definitive surgery for EA in patients with trisomy 18 syndrome may provide enhanced respiratory stability, thereby improving the survival‐to‐discharge rate and overall quality of life for patients and their families.

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Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula

Cited by 154 publications

References 32 publications

Perioperative management of esophageal atresia/tracheo‐esophageal fistula: An analysis of data of 101 consecutive patients

Perioperative management of esophageal atresia/tracheo‐esophageal fistula: An analysis of data of 101 consecutive patients

Thoracoscopic approach for complications after esophageal atresia repair: initial experience

Impact of definitive surgery for esophageal atresia on long‐term outcomes in patients with trisomy 18

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