Costal cartilage grafting for repair of a recurrent tracheoesophageal fistula in a 1.6-kg baby with esophageal atresia

Abstract

A large intraoperative tracheal tear occurred during correction of a type III esophageal atresia in a 1,630-g premature baby. It was repaired by primary suture. Recurrence of the tracheoesophageal fistula (TEF) was treated operatively with esophageal exclusion and costal cartilage grafting (CCG) onto the tracheal defect. At 3 months of age, successful esophageal reconstruction was performed using a posterior mediastinal colonic interposition. On 27-month follow-up, the child was symptom-free and thriving. Surgical options for TEF recurrence and intraoperative management of the tracheal air leak are discussed. CCG is advocated as an attractive material for tracheal repair even in low-weight prematures.

Laparoscopically harvested omental flap for recurrent tracheoesophageal fistula in a newborn baby

“…When a surgeon decides to use a flap as an interposition tissue between the sutured trachea and the esophagus, it is traditionally done using a surrender tissue such as a pericardial flap, an intercostal pedicle flap, or a costal cartilage grafting. 2,3 The use of the great omentum as a natural tissue to fill a space or cover a defect has been described in adult surgery, especially in cancer surgery or wall defect reconstruction. 4 This flap offers several practical advantages: adaptable size of the mucosal patch, great plasticity (including the omentum), and large length and size of the pedicle.…”

Tracheal agenesis: management of the first 10 months of life

“…Surgical options for correction could be: (i) tracheal reconstruction with costal cartilage (7,8); (ii) an ideal graft, if possible, could be a rigid stent, in order to permit and keep lumen stability of the common tracheo‐esophagus, provided that it would allow normal growth and development (9–11). However, the long‐term survival of infants with tracheal agenesis awaits the development of an effective surgical technique; surviving surgical transplantation of the whole trachea has not been accomplished even in animal models (12).…”

Tracheoesophageal fistula after esophageal atresia repair: recurrent, missed or acquired

“…Vascularized pleura, pericardium and intercostal muscle flaps are most commonly used tissues for interposing (19,21). Moreover, costal cartilage graft could also be used especially in cases that were experienced tracheal injury in the initial surgery (25). The other rarely used are omental flap (26) and combination of free auricular and fascia lata graft (27).…”