Primary repair of esophageal atresia is followed by multiple diagnostic and surgical procedures.

Abstract

Background: Children born with esophageal atresia (EA) face comorbidities and complications often requiring surgery and anesthesia. We aimed to assess all procedures performed under general anesthesia during their first 12 years of life. Methods: We performed a retrospective cohort study about subsequent surgeries and procedures requiring general anesthesia in children born with type C EA between January 2007 and December 2017, with follow-up to March 2019. Results: Of 102 eligible patients, 63 were diagnosed with comorbidities, of whom 18 had VACTERL association. Follow-up time for all patients varied between 14 months and 12 years (median 7 years). The patients underwent total 637 procedures, median 4 [IQR2-7] per patient. In the first year of life, 464 procedures were performed, in the second year 69 and in the third year 29. Thirteen patients underwent no other procedures than primary EA repair. In 57 patients, 228 dilatations were performed. Other frequently performed procedures were esophagoscopy (n = 52), urologic procedures (n = 44) and abdominal procedures (n = 33). Conclusions: Patients with EA frequently require multiple anesthetics for a variety of procedures related to the EA, complications and comorbidities. This study can help care providers when counselling parents of a patient with an EA by giving them more insight into possible procedures they can be confronted with during childhood.

Unintentional Suture Fistula Between the Proximal and Distal Esophagus in a Preterm Neonate with Type C Esophageal Atresia

“…In type C EA, usually a primary end-to-end esophago-esophageal anastomosis can be constructed. 1 2 3 In this type C EA case, however, we were unexpectedly not able to make a primary anastomosis. We had no previous experience with this situation and in this report, we describe our strategy and the course of events.…”

Retrospective analysis of neurological findings in esophageal atresia: Allostatic load of disease complexity, cumulative sedation, and anesthesia exposure

“…Thus, the unique aspect of complex perioperative care in cases of long‐gap EA repair relates to prolonged sedation requiring a slow and thoughtful weaning process to prevent symptoms of withdrawal (Anand et al, 1999; Dewey, 1984; Solodiuk et al, 2019). Furthermore, irrespective of the type of EA repair, infants also undergo serial follow up esophagogastroduodenoscopies (EGD) (van Hoorn et al, 2021) requiring repeated anesthesia exposures in the first year of life to assess surgical healing and to allow for esophageal dilations to prevent anastomosis stricture formation.…”

“…Considering that patients undergo repeated follow up EGDs (van Hoorn et al, 2021) to assess healing and to identify possible complications following primary repair, we quantified anesthesia exposure in the first year of life. Our end‐point measures included: (1) the number of anesthesia events as defined by any procedure that required administration of either intravenous or inhalational anesthetics and (2) cumulative exposure to minimum alveolar concentration (MAC) equivalent hours of inhalational anesthetic agents in the first year of life.…”

Studi Literatur: Diagnosis Dan Tatalaksana Atresia Esofagus

“…Tatalaksana yang dapat dilakukan pada bayi dengan atresia esofagus adalah dengan melakukan tindakan pembedahan. Tindakan pembedahan AE primer adalah prosedur yang panjang, membutuhkan anestesi intraoperatif selama lebih dari 3 jam serta membutuhkan efek sedasi pascaoperasi selama beberapa hari (van Hoorn et al, 2021). Tindakan pembedahan dilakukan dengan menggunakan anastesi umum dan juga pemasangan Endotracheal Tube (EET).…”