Outcome of primary repair in extremely and very low-birth-weight infants with esophageal atresia/distal tracheoesophageal fistula

Schmidt, Andreas; Obermayr, Florian; Lieber, Justus; Gille, Christian; Fideler, Frank; Fuchs, Joerg

doi:10.1016/j.jpedsurg.2017.05.011

Cited by 32 publications

(24 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…All three patients with recurrent TEF underwent revisional surgery for fistula ligation. Anastomotic stricture was treated with endoscopic dilatations in all cases (median 5 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] dilatations).…”

Section: Resultsmentioning

confidence: 99%

“…Prematurity is largely associated with low birth weight. Therefore, the postoperative outcome of EA/ TEF patients has been commonly evaluated relating to body weight at birth [3,5,10,11,13,14]. Seitz et al supported the surgical approach of a primary anastomosis in VLBW or ELBW infants with EA/TEF in the absence of other significant anomalies [11].…”

Section: Prognostic Classification Systemsmentioning

confidence: 99%

“…Prematurity, birth weight and/or additional anomalies are usually considered crucial factors in determing the outcome of EA/TEF patients [3,5,6,8,9]. Nevertheless, the optimal surgical management of this selective group of patients with EA/TEF remains controversial [4,5,[10][11][12][13][14]. Several authors postulated that staged repair of EA/ TEF including primary TEF closure and secondary, delayed esophageal anastomosis in premature infants with low birth weights resulted in a lower rate of anastomotic complications, and thus should be considered the preferred surgical approach in this group of patients [4,5].…”

mentioning

confidence: 99%

See 2 more Smart Citations

Low gestational age is associated with less anastomotic complications after open primary repair of esophageal atresia with tracheoesophageal fistula

et al. 2020

View full text Add to dashboard Cite

Background: The aim of this study was to evaluate anastomotic complications after primary one-staged esophageal atresia (EA) repair relating to the patients`gestational age (GA). Methods: Retrospective data analyses of patients who underwent closure of tracheoesophageal fistula (TEF) and primary esophageal anastomosis from 01/2007 to 12/2018 in two pediatric surgical centers. Exclusion of EA other than Gross type C, long-gap EA, minimal invasive or staged approach. Postoperative complications during the first year of life were assessed. Associated malformations, the incidence of infant respiratory distress syndrome (IRDS) and intraventricular bleeding were analyzed. Results: Inclusion of 75 patients who underwent primary EA repair. Low GA was associated with significantly lower incidence of anastomotic complications (p = 0.019, r = 0.596, 95% CI 0.10-0.85). Incidence of anastomotic leakage (0% vs. 5.5%; p = 0.0416), recurrent TEF (0% vs. 5.5%; p = 0.0416) und anastomotic stricture (0% vs. 14.5%; p = 0.0019) was significantly lower in patients < 34 gestational weeks. Incidence of IRDS (55% vs. 0%; p < 0.0001) and intraventricular bleeding (25% vs. 3.6%; p = 0.0299) was significantly higher in patients < 34 gestational weeks. Conclusions: Despite prematurity-related morbidity, low GA did not adversely affect surgical outcome after primary EA repair. Low GA was even associated with a better anastomotic outcome indicating feasibility and safety of primary esophageal reconstruction.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Prognostic Classification Systemsmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Low gestational age is associated with less anastomotic complications after open primary repair of esophageal atresia with tracheoesophageal fistula

et al. 2020

View full text Add to dashboard Cite

show abstract

“…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%

“…This contrasts with the results of Seitz et al (21), who shared their data on four patients with EA type C and VLBW treated with primary repair (AI and AS in 25% of their patients) in 2006. Nine years later, the researchers published their data with 11 patients and compared the outcome to open primary repair in patients with birth weight >1,500 g, stating anastomotic complications are not related to factors of tissue prematurity and birth weight (15). A possible explanation for these outstanding results may be because the university hospital has a standard structure for treating these complex cases, once more demonstrating the importance of centralization.…”

Section: Surgical Approachmentioning

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.

View full text Add to dashboard Cite

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.

show abstract

Quantifying Upper Aerodigestive Sequelae in Esophageal Atresia/Tracheoesophageal Fistula Neonates

et al. 2021

View full text Add to dashboard Cite

Objectives We examined rates of upper aerodigestive tract (UADT) procedures in a multi‐institutional cohort of neonates with esophageal atresia/tracheoesophageal fistula (EA/TEF) to estimate secondary UADT pathology. Methods A retrospective cohort study was performed using a previously‐validated population of patients with EA/TEF within the Pediatric Health Information System (PHIS) between 2007 and 2015. ICD‐9/10‐CM codes for aerodigestive procedures were examined from 2007 to 2020: 1) diagnostic direct laryngoscopy and/or bronchoscopy (DLB), 2) DLB with intervention, 3) tracheostomy, 4) gastrostomy, 5) fundoplication, 6) aortopexy, 7) laryngotracheoplasty, and 8) esophageal dilation. Associations between procedures and demographics, length of gestation, and weight were estimated using generalized linear mixed models. Results We identified 2,509 patients with EA/TEF from 47 hospitals, 56.7% male and 43.3% female. Median length of stay for the first admission was 24 days (interquartile range: 12–55). Of these patients, 1,943 (77.4%) had at least one aerodigestive procedure within 14 admissions. Specifically, 1,635 (65.2%) underwent diagnostic DLB, 85 (3.4%) DLB with intervention, 167 (6.7%) tracheostomy, 1,043 (41.2%) gastrostomy, 211 (11.0%) fundoplication, 52 (2.1%) aortopexy, 161 (6.4%) laryngotracheoplasty, and 207 (8.3%) esophageal dilation. Preterm gestation increased odds of tracheostomy (adjusted odds ratio (OR) 2.4, 95% confidence interval (CI) 1.5–3.7), gastrostomy (OR 2.1, CI 1.7–2.7), fundoplication (OR 1.7, CI 1.1–2.4), aortopexy (OR 5.8, CI 2.1–16.1), and esophageal dilation (OR 2.0, CI 1.4–3.0). Very low birth weight (<1,500 g) increased odds of gastrostomy (OR 2.5, CI 1.6–3.8). Conclusion Patients with EA/TEF frequently have aerodigestive sequelae. This work helps quantify aerodigestive needs in neonates with EA/TEF, suggesting early otolaryngology evaluation in their care. Level of Evidence 3 Laryngoscope, 132:695–700, 2022

show abstract

Outcome of primary repair in extremely and very low-birth-weight infants with esophageal atresia/distal tracheoesophageal fistula

Cited by 32 publications

References 27 publications

Low gestational age is associated with less anastomotic complications after open primary repair of esophageal atresia with tracheoesophageal fistula

Low gestational age is associated with less anastomotic complications after open primary repair of esophageal atresia with tracheoesophageal fistula

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

Quantifying Upper Aerodigestive Sequelae in Esophageal Atresia/Tracheoesophageal Fistula Neonates

Contact Info

Product

Resources

About