Esophageal atresia and tracheoesophageal fistula: a review of 25 years' experience

Sharma, Aarti; Shekhawat, N. S.; Agrawal, Lila Dhar; Chaturvedi, Vinita; Kothari, Sunil; Goel, Divya

doi:10.1007/s003830000393

Cited by 27 publications

(27 citation statements)

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“…40.7% cases reached within first 24 hours in spite of 75% deliveries at hospital. 6 Agarwal et al in AIIMS hospital reported that the patients presenting within 24 hours were 44% and similar data (46%) was also obtained by Sharma AK et al 7,8 Traveling long distance, poor transport system and poverty are also the contributory factors.…”

Section: Discussionsupporting

confidence: 61%

Esophageal atresia and Tracheoesophageal fistula with associated anomalies in a tertiary care hospital of north India

Prasad¹

2017

Int Surg J

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Background: Esophageal atresia (EA) with or without Tracheoesophageal fistula (TEF) has been described as the epitome of pediatric surgery and the management of these neonates require high degree of skill, manpower and tertiary care. This clinical study was undertaken to identify the EA and TEF cases along with the pattern of associated anomalies causing mortality in Varanasi .Methods: This prospective study included 53 patients of EA with TEF who underwent primary esophageal anastomosis. Their clinical profile, time of presentation, various associated anomalies, sex distribution, and their effect on mortality and morbidity were observed.Results: Mortality was high (41.64%) among patients who reached the tertiary centre late i.e. >24 hours. The incidence of low birth weight babies is approximately 75% and mortality rate increased with low birth weight. Almost 2/3 of patients had clinical or radiological evidence of pneumonia. The mortality was very high in severe pneumonia 66.7% as compared to 15% patients without pneumonia. Septicaemia and leak were most common complications. The mortality in septicemic patients is high (77.8%). The overall incidence of associated anomalies was 47%. Early surgical intervention improved the survival of EA with TEF with major GIT associated anomalies. The overall survival rate was 60.37% and mortality was 39.67%.Conclusions: Although we have improved a lot in managing these cases of EA with TEF, but we have to do much more to achieve our goal of near 100% survival.

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Section: Discussionsupporting

confidence: 61%

Esophageal atresia and Tracheoesophageal fistula with associated anomalies in a tertiary care hospital of north India

Prasad¹

2017

Int Surg J

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“…Sharma et al gave a method of suturing the upper puch to the anti spatulated end of the lower pouch in 1994. This was followed by circular myotomy which created a large anastomosis [8]. Melek et al gave a plus shaped incision over the upper pouch creating a zigzag anastomosis [2,9,10].…”

Section: Discussionmentioning

confidence: 99%

“…The nature of anastomosis has been controversial and different approaches have been suggested in literature [2,8,9,14]. The earliest teaching still used in the majority of centers worldwide has been a circular anastomosis in a single transverse plane [10,[15][16][17].…”

Section: Discussionmentioning

confidence: 99%

“…The type of anastomosis to be done has been a subject of debate [1,2,6,7]. Classically a transverse circular anastomosis has been the teaching with proper mobilization of both the upper and lower esophageal pouches [7,8]. We have attempted to modify the technique of anastomosis to reduce the complication rate, thereby reducing patient morbidities.…”

Section: Introductionmentioning

confidence: 99%

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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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“…[1][2][3][4] A transverse circular anastomosis by extra pleural approach with proper mobilization of both the upper and lower esophageal pouches is the surgical procedure of choice. 4,5 Even following a proper anastomosis, the condition is often complicated by anastomotic leaks and strictures. 6 These complications mandate either re-exploration or a gastrostomy as a life-saving maneuvers.…”

Section: Introductionmentioning

confidence: 99%

Strategies for optimizing surgical outcome in patients with esophageal atresia with tracheo-esophageal fistula

Patil

Prakash

2017

Int Surg J

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Background: There have been major advances in the surgery for esophageal atresia (EA) and tracheo-esophageal fistula (TEF) with survival now exceeding 90%. The standard open approach to EA and distal TEF has been well described and essentially unchanged in last 60 years. Improved survival in recent decades is most attributable to advances in neonatal surgical techniques, anaesthesia and perioperative care. In a prospective randomized trial, we analysed the effect of pleural flap wrap around the anastomosis and post-operative elective ventilation support for 48 hours as main strategies towards improving the outcome in such patients.Methods: Twenty five neonates who were diagnosed as a case on tracheo-esophageal fistula (TEF) on clinical and radiological basis were selected for the study. All babies were more than 2kg weight and were operated within first two days of life after optimization. There was no evidence of any congenital heart disease or any other associated anomaly. In all patients primary esophageal anastomosis was possible which was subsequently covered by pleural flap wrap. All the patients were put post-operatively on ventilator electively for 48 hours. Contrast study was done on post-operative day five and feeding was started subsequently.Results: Postoperative surgical outcome was very good. Out of twenty five cases, 24 patients survived and only one baby died secondary to anastomotic leak and sepsis. Twenty three babies were discharged on post-operative day 8. One baby was on ventilator for 6 days and discharged on postoperative day 15. All patients are on regular follow up.Conclusions: Surgical outcome in patients with esophageal atresia and tracheo-esophageal fistula in neonates can be improved with use of pleural flap wrap and elective post-operative ventilation.

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Esophageal atresia and tracheoesophageal fistula: a review of 25 years' experience

Cited by 27 publications

References 0 publications

Esophageal atresia and Tracheoesophageal fistula with associated anomalies in a tertiary care hospital of north India

Esophageal atresia and Tracheoesophageal fistula with associated anomalies in a tertiary care hospital of north India

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

Strategies for optimizing surgical outcome in patients with esophageal atresia with tracheo-esophageal fistula

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