State of Play: Eight Decades of Surgery for Esophageal Atresia

Zimmer, Julia; Eaton, Simon; Murchison, L; Coppi, Paolo De; Ure, Benno M.; Dingemann, Carmen

doi:10.1055/s-0038-1668150

Cited by 45 publications

(41 citation statements)

References 120 publications

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“…1,2 The malformation is characterized by a discontinuity of the esophagus with or without tracheoesophageal fistula. Since the first successful primary repair of esophageal atresia in 1941, improvements in operative and perioperative care have led to better outcomes, and mortality has decreased to a single-digit range [3][4][5] with most deaths due to comorbidities. Evolution from concerns about mortality to concerns about morbidity and quality-of-life issues has occurred, 5 and long-term morbidity remains high until adulthood.…”

Section: Introductionmentioning

confidence: 99%

ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: Diagnostics, Preoperative, Operative, and Postoperative Management

et al. 2019

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Introduction Many aspects of the management of esophageal atresia (EA) and tracheoesophageal fistula (TEF) are controversial and the evidence for decision making is limited. Members of the European Reference Network for Rare Inherited Congenital Anomalies (ERNICA) conducted a consensus conference on the surgical management of EA/TEF based on expert opinions referring to the latest literature. Materials and Methods Nineteen ERNICA representatives from nine European countries participated in the conference. The conference was prepared by item generation, item prioritization by online survey, formulation of a final list containing the domains diagnostics, preoperative, operative, and postoperative management, and literature review. The 2-day conference was held in Berlin in October 2018. Anonymous voting was conducted via an internet-based system. Consensus was defined when 75% of the votes scored 6 to 9. Results Fifty-two items were generated with 116 relevant articles of which five studies (4.3%) were assigned as level-1evidence. Complete consensus (100%) was achieved on 20 items (38%), such as TEF closure by transfixing suture, esophageal anastomosis by interrupted sutures, and initiation of feeding 24 hours postoperatively. Consensus ≥75% was achieved on 37 items (71%), such as routine insertion of transanastomotic tube or maximum duration of thoracoscopy of 3 hours. Thirteen items (25%) were controversial (range of scores, 1–9). Eight of these (62%) did not reach consensus. Conclusion Participants of the conference reached significant consensus on the management of patients with EA/TEF. The consensus may facilitate standardization and development of generally accepted guidelines. The conference methodology may serve as a blueprint for further conferences on the management of congenital malformations in pediatric surgery.

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Section: Introductionmentioning

confidence: 99%

ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: Diagnostics, Preoperative, Operative, and Postoperative Management

et al. 2019

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“…Esophageal stricture, anastomotic leakage, and recurrent TEF are well‐known complications after EA repair. Previous studies found the esophageal stricture rate to vary between 25% and 42%, the anastomotic leakage rate between 11% and 23%, and the recurrent TEF rate between 4% and 9% . In a recent meta‐analysis, a comparison of thoracoscopic and open approaches found that the thoracoscopic approach notably reduced the length of hospital stay and time to oral refeeding, but it was associated with a longer operative time.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies found the esophageal stricture rate to vary between 25% and 42%, the anastomotic leakage rate between 11% and 23%, and the recurrent TEF rate between 4% and 9%. 2,3 In a recent meta-analysis, a comparison of thoracoscopic and open approaches found that the thoracoscopic approach notably reduced the length of hospital stay and time to oral refeeding, but it was associated with a longer operative time. The rate of postoperative complications, such as leaks and strictures, was similar between both approaches.…”

Section: Discussionmentioning

confidence: 99%

“…However, postoperative complications still occur in a large percentage of patients. Anastomotic dehiscence, esophageal stricture, and recurrent tracheoesophageal fistula (TEF) are among the most common complications after EA repair . These complications may have great relevance to the short‐ and long‐term outcomes of patients who have undergone EA …”

Section: Introductionmentioning

confidence: 99%

“…Anastomotic dehiscence, esophageal stricture, and recurrent tracheoesophageal fistula (TEF) are among the most common complications after EA repair. 2 These complications may have great relevance to the shortand long-term outcomes of patients who have undergone EA. 2,3 Minimally invasive techniques have revolutionized surgery by offering certain benefits over conventional procedures, such as less postoperative pain, shorter hospital stay, and superior cosmetic results.…”

Section: Introductionmentioning

confidence: 99%

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Thoracoscopic approach for complications after esophageal atresia repair: initial experience

Novillo

Castro

Lenz

et al. 2019

Asian J Endoscop Surgery

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Introduction Improvements in technology and health care have helped reduce morbidity and mortality in patients with esophageal atresia. However, postoperative complications such as dehiscences, strictures, and recurrent fistulas still occur in a large percentage of patients. Here, we present our initial experience using the thoracoscopic approach for complications after esophageal atresia repair. Methods We retrospectively analyzed the medical records of patients who developed complications after esophageal atresia repair and underwent thoracoscopic reoperation at two centers. Anastomotic leakage, anastomotic stricture, and recurrent tracheoesophageal fistula were assessed as complications after esophageal atresia repair. Results We reoperated on four patients (range of age 3 days ‐ 2 years) by thoracoscopy. Two patients who had undergone thoracoscopic atresia repair presented with anastomotic dehiscence. The anastomoses were thoracoscopically reconstructed without tension. One patient had undergone thoracoscopic atresia repair presented with esophageal stricture refractory to endoscopic dilatations. Thoracoscopic esophagoesophagostomy was performed in this 2‐year‐old patient. One patient who had undergone esophageal atresia repair and tracheoesophageal fistula closure by thoracotomy presented with a recurrent fistula at 1 year of age. The patient underwent thoracoscopic fistula closure with a 5‐mm endostapler. All patients remain asymptomatic after reoperation. Conclusions Reoperation after esophageal atresia repair is challenging and carries a relatively high risk of developing complications. Compared to conventional surgery, the thoracoscopic approach in experienced hands offers better visualization and more accurate dissection and drainage of the thoracic cavity. Therefore, we want to encourage the use of thoracoscopy in the treatment of complications after esophageal atresia repair.

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Preservation of the azygos vein versus ligation of the azygos vein during primary surgical repair of congenital esophageal atresia

Korang

Hildorf

Oehlenschlæger

et al. 2021

Cochrane Database of Systematic Reviews

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State of Play: Eight Decades of Surgery for Esophageal Atresia

Cited by 45 publications

References 120 publications

ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: Diagnostics, Preoperative, Operative, and Postoperative Management

ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: Diagnostics, Preoperative, Operative, and Postoperative Management

Thoracoscopic approach for complications after esophageal atresia repair: initial experience

Preservation of the azygos vein versus ligation of the azygos vein during primary surgical repair of congenital esophageal atresia

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