Transpleural repair of esophageal atresia without a primary gastrostomy: 240 patients treated between 1951 and 1983

Bishop, P.J.; Klein, Michael D.; Philippart, Arvin I.; Hixson, Douglas; Hertzler, Jack H.

doi:10.1016/s0022-3468(85)80050-6

Cited by 72 publications

(20 citation statements)

References 5 publications

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“…However, in our series, the incidence of CHD was similar in all EA types. The MCHD diagnosed in our series (Table 2) had a distribution similar to that in other series [15][16][17][18][19][20]. Our prevalence of MCHD (52%) was similar to that published by Spitz [4] and the distribution of the clinical material among the three groups and the mortality in each one was comparable as well ( Table 3).…”

Section: Discussionsupporting

confidence: 87%

Impact of preoperative diagnosis of congenital heart disease on the treatment of esophageal atresia

et al. 2005

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Congenital heart disease (CHD) has a major impact on the survival of babies with esophageal atresia (EA). The present study assesses whether early diagnosis influences the management strategies in a large series of EA. Cases of EA treated between 1982 and 2002 were retrospectively divided into groups according to the presence or absence of CHD and to whether this was diagnosed or not prior to tracheo-esophageal fistula repair. Patients were also staged according to Spitz's classification in which major congenital heart disease (MCHD) are those associated with cyanosis and/or heart failure requiring surgery. Comparisons between groups of patients were made by standard statistical tests. Among 195 babies with EA (99 boys and 96 girls), 82 (42%) had CHD (31 boys, 39% and 51 girls, 61%, chi2 P < 0.05) and 43 out of these 82 (52%) had MCHD. Six children died without treatment. CHD was diagnosed prenatally in six cases and before EA repair in 26 cases. The diagnoses were missed in 12 instances (in five it was a MCHD). Regardless of preoperative diagnosis of right aortic arch in 3/6 cases, the oesophagus was approached from the right thorax in all cases and only in one of them the operation was not completed due to hemodynamic instability. There were 145/195 (75%) Spitz group I patients; 44/195 (22%) were group II and 6/195 (3%) group III. The mortality was respectively 9.5, 59 and 83%. We lost 15/113 (13%) babies with EA without CHD, 4/39 (10.2%) with EA and CHD and 26/43 (60%) with EA and MCHD. In children with CHD diagnosed prior to the esophageal operation 8/26 (30.7%) died and among those without diagnoses 3/12 (25%) died, (chi2 P> 0.1). 1. CHD was diagnosed after EA repair in one-third of cases. 2. Preoperative diagnosis of CHD changed the operative indication only in one case. 3. Survival after treatment for EA was not influenced by the moment or the accuracy of the diagnosis of CHD in this series. 4. With only a few exceptions, associated CHD should not change the strategies of EA repair.

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Section: Discussionsupporting

confidence: 87%

Impact of preoperative diagnosis of congenital heart disease on the treatment of esophageal atresia

et al. 2005

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“…Moreover, major pleural tears during dissection were not met in any case and only minor tears were reported in 4 cases only and this didn't affect the postoperative outcome. Anastomotic leaks were reported to occur in 14-21% of patients with EA [8,[15][16][17]. Our 16% incidence of anastomotic leak falls within the same range.…”

Section: Discussionsupporting

confidence: 72%

Balloon Dissection for Extra Pleural Approach in Tracheoesophageal Fistula Repair; A Novel Technique

Elqader¹,

Ghnnam²

2017

IJCTS

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Abstract:Objective: The extra-pleural approach for the tracheoesophageal fistula is preferred by most of pediatric surgeons because the possible substantial anastomotic leak will end in a fistula rather than an empyema. The problem with this technique that it is time consuming for pleural separation and liable for pleural tears. We studied a new method for using of Foley's catheter balloon to push the pleura away from the chest wall in an easier manner and shorter time. Method: A 25 neonate with tracheoesophageal fistula was managed with the extra-pleural approach using the Foley's catheter balloon as a method of pleural separation. Results: The mean time for pleural dissection was 4.5 m (266.4 sec) with a range of 2 m, 47 sec (167 sec) -6 m, 18 sec (378 sec). Only 4 minor pleural tears were encountered (16%) that passed smoothly. 4 Anastomotic leaks occurred that were managed conservatively and 2 mild Anastomotic strictures (8%) occurred and were managed conservatively. Conclusion: Balloon dissection is a valuable addition to management of esophageal atresia. It accomplishes pleural separation from the rib cage in short time and easy manner with nearly 0% incidence of significant pleural tears. Moreover, it improves the outcome of possible postoperative anastomotic leak without adding to the patient's morbidity or the hospital cost.

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“…Forty-two patients (46%) had other congenital malformations besides their EA. The distribution of the 5 types of atresia as described by Gross [16] is the same as in other large studies [17,18].…”

Section: Patient Characteristicsmentioning

confidence: 68%

Esophagitis and Barrett esophagus after correction of esophageal atresia

Deurloo

Ekkelkamp

Taminiau

et al. 2005

Journal of Pediatric Surgery

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Transpleural repair of esophageal atresia without a primary gastrostomy: 240 patients treated between 1951 and 1983

Cited by 72 publications

References 5 publications

Impact of preoperative diagnosis of congenital heart disease on the treatment of esophageal atresia

Impact of preoperative diagnosis of congenital heart disease on the treatment of esophageal atresia

Balloon Dissection for Extra Pleural Approach in Tracheoesophageal Fistula Repair; A Novel Technique

Esophagitis and Barrett esophagus after correction of esophageal atresia

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