Cervical repair of congenital tracheoesophageal fistula: Complications lurking!

Conforti, Andrea; Iacusso, Chiara; Valfrè, Laura; Trozzi, Marilena; Bottero, Sergio; Bagolan, Pietro

doi:10.1016/j.jpedsurg.2016.06.010

Cited by 23 publications

(21 citation statements)

References 12 publications

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“…In children with aero-digestive malformations, vocal cord paresis or paralysis, although uncommon, can occur after surgical repair [ 44 , 45 , 46 , 47 , 48 ]. Bilateral paralysis is a potentially life-threatening condition because it can lead to complete airway obstruction, requiring long-term tracheostomy placement, whereas the mildest cases may resolve spontaneously [ 44 , 45 , 46 , 47 , 48 ]. Moreover, vocal cord paralysis can also be lateralized and not lead to airway obstruction [ 44 , 45 , 46 , 47 , 48 ].…”

Section: Upper Respiratory Tract Involvementmentioning

confidence: 99%

“…Bilateral paralysis is a potentially life-threatening condition because it can lead to complete airway obstruction, requiring long-term tracheostomy placement, whereas the mildest cases may resolve spontaneously [ 44 , 45 , 46 , 47 , 48 ]. Moreover, vocal cord paralysis can also be lateralized and not lead to airway obstruction [ 44 , 45 , 46 , 47 , 48 ]. However, all these children are at increased risk of swallowing dysfunction and aspiration [ 47 , 48 ].…”

Section: Upper Respiratory Tract Involvementmentioning

confidence: 99%

“…Moreover, vocal cord paralysis can also be lateralized and not lead to airway obstruction [ 44 , 45 , 46 , 47 , 48 ]. However, all these children are at increased risk of swallowing dysfunction and aspiration [ 47 , 48 ]. Their ability to swallow has to be systematically evaluated to reduce risks of respiratory complications.…”

Section: Upper Respiratory Tract Involvementmentioning

confidence: 99%

“…The incidence of vocal cord dysfunction in patients who have undergone surgical repair varies significantly among studies and is reported in 3% to 30% of the cases according to the criteria used to evaluate the problem [ 44 , 45 , 46 ]. A recent Italian retrospective analysis documented that postoperative vocal cord paralysis is more common in patients with type B CEA (CEA, with a proximal TEF, or a TEF connecting between the upper pouch of the esophagus and the trachea) and E CEA (TEF connecting between the esophagus and the trachea, without CEA) [ 47 ]. Moreover, the thoracoscopy repair seemed to be associated with a higher rate of vocal cord impairment [ 48 ].…”

Section: Upper Respiratory Tract Involvementmentioning

confidence: 99%

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Respiratory Morbidity in Children with Repaired Congenital Esophageal Atresia with or without Tracheoesophageal Fistula

Patria

Ghislanzoni

Macchini

et al. 2017

IJERPH

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Congenital esophageal atresia with or without tracheoesophageal fistula (CEA ± TEF) is a relatively common malformation that occurs in 1 of 2500–4500 live births. Despite the refinement of surgical techniques, a considerable proportion of children experience short- and long-term respiratory complications, which can significantly affect their health through adulthood. This review focuses on the underlying mechanisms and clinical presentation of respiratory morbidity in children with repaired CEA ± TEF. The reasons for the short-term pulmonary impairments are multifactorial and related to the surgical complications, such as anastomotic leaks, stenosis, and recurrence of fistula. Long-term respiratory morbidity is grouped into four categories according to the body section or function mainly involved: upper respiratory tract, lower respiratory tract, gastrointestinal tract, and aspiration and dysphagia. The reasons for the persistence of respiratory morbidity to adulthood are not univocal. The malformation itself, the acquired damage after the surgical repair, various co-morbidities, and the recurrence of lower respiratory tract infections at an early age can contribute to pulmonary impairment. Nevertheless, other conditions, including smoking habits and, in particular, atopy can play a role in the recurrence of infections. In conclusion, our manuscript shows that most children born with CEA ± TEF survive into adulthood, but many comorbidities, mainly esophageal and respiratory issues, may persist. The pulmonary impairment involves many underlying mechanisms, which begin in the first years of life. Therefore, early detection and management of pulmonary morbidity may be important to prevent impairment in pulmonary function and serious long-term complications. To obtain a successful outcome, it is fundamental to ensure a standardized follow-up that must continue until adulthood.

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Section: Upper Respiratory Tract Involvementmentioning

confidence: 99%

Section: Upper Respiratory Tract Involvementmentioning

confidence: 99%

Section: Upper Respiratory Tract Involvementmentioning

confidence: 99%

Section: Upper Respiratory Tract Involvementmentioning

confidence: 99%

See 2 more Smart Citations

Respiratory Morbidity in Children with Repaired Congenital Esophageal Atresia with or without Tracheoesophageal Fistula

Patria

Ghislanzoni

Macchini

et al. 2017

IJERPH

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show abstract

“…Accordingly, patients who underwent extensive mobilization of the upper esophageal pouch, who required cervical esophagostomy, or with a more difficult postoperative period have a higher prevalence of VCD. 53,[57][58][59] The high risk of cervical dissection to predispose to VCD is further confirmed by its high prevalence in patient with isolated TEF, that are more frequently closed through a cervical approach. A recent multicenter study showed that isolated TEF is the type of EA with the highest prevalence of VCD 10 and Zani et al report a 50% prevalence of VCD in a series of 16 patients with isolated TEF, all undergoing cervicotomy repair.…”

Section: Vocal Cord Dysfunctionmentioning

confidence: 97%

Perioperative Complications of Esophageal Atresia

2018

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Current survival rate of infants with esophageal atresia with/without tracheoesophageal fistula (EA/TEF) exceeds 90% and great interest is dedicated to the long-term outcomes and complications. However, perioperative complications represent a significant burden to the EA/TEF infants and a technical challenge for the surgeon. In this review, we will focus on the most frequent perioperative complications specific of EA/TEF to describe their predisposing factors, possible preventive measures, and treatment options.

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Slide Tracheoplasty for Repair of Complex Tracheoesophageal Fistulas

et al. 2021

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Objectives/Hypothesis: Repair of large, recurrent, and complex tracheoesophageal fistulas (TEFs) is challenging and numerous different surgical approaches exist. These various techniques each carry a set of risks and possible complications such as fistula recurrence, tracheal stenosis or pouches, esophageal stenosis, and recurrent laryngeal nerve injury. Slide tracheoplasty is a reconstructive technique successfully used in many different airway pathologies, including TEF repair. This study examines the success, limits, and complications related to slide tracheoplasty for repair of complex TEFs.Study Design: Retrospective chart review. Methods: Patients undergoing TEF repair using a cervical or thoracic approach slide tracheoplasty, at a single institution, between July 2008 and December 2019 were retrospectively reviewed. Demographic data, comorbidities, TEF etiology and surgical history, slide tracheoplasty details and outcomes, and postoperative complication data were examined using descriptive statistics.Results: Twenty-six patients underwent 27 slide tracheoplasties for TEF (20 cervical approaches, 7 thoracic approaches) with a mean age of 5.2 years (IQR 0.7-7.6) at time of surgery. The most common TEF etiologies included congenital (n = 13), tracheostomy tube erosion (n = 5), and button battery ingestion (n = 4). Fistulas ranged in size from <0.5 mm to 4 cm and 59% had previous endoscopic or open repairs. There were two TEF recurrences (7.4%), one of which was successfully revised and the other which was treated with stent placement. Postoperative complications included dehiscence (3.7%), unilateral vocal fold paralysis (3.7%), and mild tracheal stenosis (18.5%).Conclusions: Slide tracheoplasty is an effective surgical technique for treating complex congenital and acquired TEFs with lower rates of complications when compared to other techniques.

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Cervical repair of congenital tracheoesophageal fistula: Complications lurking!

Cited by 23 publications

References 12 publications

Respiratory Morbidity in Children with Repaired Congenital Esophageal Atresia with or without Tracheoesophageal Fistula

Respiratory Morbidity in Children with Repaired Congenital Esophageal Atresia with or without Tracheoesophageal Fistula

Perioperative Complications of Esophageal Atresia

Slide Tracheoplasty for Repair of Complex Tracheoesophageal Fistulas

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