The role of prophylactic chest drainage in the operative management of esophageal atresia with tracheoesophageal fistula

Between 1970 and 1979 152 infants born with the anomaly of esophageal atresia with or without tracheoesophageal fistula or of congenital tracheoesophageal fistula without atresia were treated at the Royal Alexandra Hospital for Children, Sydney. Recent developments in endoscopic equipment and new techniques of anesthesia allow detailed examination of the respiratory tract and esophagus with minimum trauma and maximum safety. Symptomatology relating to the airway and to the esophagus after surgical repair often occurs in patients who may have tracheomalacia, esophageal anastomotic stricture, esophageal reflux and sometimes recurrent or residual fistula. A definite diagnosis of tracheomalacia can be made by finding the typical triad of anteroposterior narrowing of the tracheal lumen, weakening of the semicircular-shaped cartilages and forward ballooning of the widened posterior membranous tracheal wall. Careful examination of the trachea and esophagus allows identification of an elusive recurrent fistula or an H-type fistula. As the primary results of surgery for esophageal atresia and tracheoesophageal fistula improve, long-term problems are becoming increasingly important. The role of the pediatric endoscopist is vital in the care of these patients.

Download Full-text

Post-operative management of esophageal atresia–tracheoesophageal fistula and gastroesophageal reflux: A Canadian Association of Pediatric Surgeons annual meeting survey

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2014.02.052 ◽

2014 ◽

Vol 49 (5) ◽

pp. 716-719 ◽

Cited By ~ 17

Author(s):

Anna C. Shawyer ◽

Julia Pemberton ◽

Helene Flageole

Keyword(s):

Gastroesophageal Reflux ◽

Annual Meeting ◽

Esophageal Atresia ◽

Tracheoesophageal Fistula ◽

Operative Management ◽

Canadian Association

Download Full-text

Role of preoperative 3D CT reconstruction for evaluation of patients with esophageal atresia and tracheoesophageal fistula

Pediatric Surgery International ◽

10.1007/s00383-012-3111-9 ◽

2012 ◽

Vol 28 (10) ◽

pp. 961-966 ◽

Cited By ~ 11

Author(s):

Santosh Kumar Mahalik ◽

Kushaljeet Singh Sodhi ◽

K. L. Narasimhan ◽

K. L. N. Rao

Keyword(s):

Esophageal Atresia ◽

Tracheoesophageal Fistula ◽

3D Ct ◽

Ct Reconstruction ◽

3D Ct Reconstruction

Download Full-text

Novel Technique: Noninvasive Ventilation Support Flexible Endoscopy for Preoperative Manage Neonates of Esophageal Atresia with Tracheoesophageal Fistula and Respiratory Distress

10.22541/au.162730403.35398464/v1 ◽

2021 ◽

Author(s):

Wen-Jue Soong ◽

YI-TING YEH ◽

PEI-CHEN TSAO ◽

Chieh-Ho Chen ◽

Yi-Hung Sung ◽

...

Keyword(s):

Respiratory Distress ◽

Esophageal Atresia ◽

Noninvasive Ventilation ◽

Tracheoesophageal Fistula ◽

Operative Management ◽

Flexible Endoscopy ◽

Great Artery ◽

Tube Placement ◽

Positive Pressure ◽

Gastric Decompression

Introduction Pre-operative management of neonates with esophageal atresia and tracheoesophageal fistula (EA/TEF) requiring positive pressure ventilation (PPV) support is clinically challenging. This study evaluates the safety, feasibility and value of flexible endoscopy with noninvasive ventilation and sustained pharyngeal inflation (FE-NIV-SPI) in diagnosis and placing a naso-tracheo-fistula-gastric (NTFG) tube before surgery. Methods A retrospective study conducted from 2017 to 2020 in neonates with Type-C EA/TEF and respiratory distress, where FE-NIV-SPI performed with NTFG tube placement before surgery. Results Five neonates were collected, one with duodenal atresia and one with transposition of great artery. At FE-NIV-SPI, median body weight was 2,399 g and mean age was 15.2 hours. Four neonates yielded severe (>80% collapsed) tracheomalacia. With this FE-NIV, all tracheal, fistulas and esophageal lumens could clearly assess and manage. All fistulas were less than 8mm proximal to carina with mean orifice width of 5 mm. All NTFG tubes placed successfully after confirmed the EA/TEF. Three neonates had co-intubated with nasal endotracheal tube and 2 neonates had received nasal prongs PPV. Mean procedural time of FE-NIV was 13.6±4.5 minutes. All neonates received gastric decompression and feeding via NTFG tubes for mean of 11.4±18.2 days and had stable pre-surgical courses. No adverse associated complication noted. Conclusion FE-NIV-SPI technique enables safe and accurate measurement of EA/TEF anatomy and placing NTFG tube. It could avert emergent gastrostomy, aid gastric decompression, feeding, and ETT intubation, improve PPV, provide pre-surgical stabilization and identify the fistula location during the surgical correction.

Download Full-text

Role of Thermal Ablation in Colorectal Cancer Lung Metastases

Cancers ◽

10.3390/cancers13040908 ◽

2021 ◽

Vol 13 (4) ◽

pp. 908

Author(s):

Alexandre Delpla ◽

Thierry de Baere ◽

Eloi Varin ◽

Frederic Deschamps ◽

Charles Roux ◽

...

Keyword(s):

Colorectal Cancer ◽

Prognostic Factors ◽

Thermal Ablation ◽

Medical Oncology ◽

Pulmonary Metastases ◽

Lung Metastases ◽

Stereotactic Ablative Radiotherapy ◽

Chest Drainage ◽

Results Of Surgery

Background: Consensus guidelines of the European Society for Medical Oncology (ESMO) (2016) provided recommendations for the management of lung metastases. Thermal ablation appears as a tool in the management of these secondary pulmonary lesions, in the same manner as surgical resection or stereotactic ablative radiotherapy (SABR). Methods: Indications, technical considerations, oncological outcomes such as survival (OS) or local control (LC), prognostic factors and complications of thermal ablation in colorectal cancer lung metastases were reviewed and put into perspective with results of surgery and SABR. Results: LC rates varied from 62 to 91%, with size of the metastasis (<2 cm), proximity to the bronchi or vessels, and size of ablation margins (>5 mm) as predictive factors of LC. Median OS varied between 33 and 68 months. Pulmonary free disease interval <12 months, positive carcinoembryonic antigen, absence of neoadjuvant chemotherapy and uncontrolled extra-pulmonary metastases were poor prognostic factors for OS. While chest drainage for less than 48 h was required in 13 to 47% of treatments, major complications were rare. Conclusions: Thermal ablation of a selected subpopulation of patients with colorectal cancer lung metastases is safe and can provide excellent LC and delay systemic chemotherapy.

Download Full-text

Impact of preservation of the azygos vein during surgical repair of esophageal atresia-tracheoesophageal fistula (EA-TEF): a systematic review and meta-analysis

Pediatric Surgery International ◽

10.1007/s00383-021-04913-2 ◽

2021 ◽

Author(s):

Deepika Kainth ◽

Sachit Anand ◽

Apoorv Singh ◽

Minu Bajpai

Keyword(s):

Systematic Review ◽

Esophageal Atresia ◽

Tracheoesophageal Fistula ◽

Surgical Repair ◽

Meta Analysis ◽

Azygos Vein

Download Full-text

The Role of Angioembolization in Hepatic Trauma

The American Surgeon ◽

10.1177/0003134820973729 ◽

2020 ◽

pp. 000313482097372

Author(s):

Ali Cadili ◽

Jonathan Gates

Keyword(s):

Gold Standard ◽

Management Strategy ◽

Operative Management ◽

Hepatic Trauma ◽

Anatomy And Physiology ◽

Liver Injuries ◽

Hepatic Injuries ◽

Non Operative Management ◽

Type Of Injury

The liver is one of the most commonly injured solid organs in blunt abdominal trauma. Non-operative management is considered to be the gold standard for the care of most blunt liver injuries. Angioembolization has emerged as an important adjunct that is vital to the success of the non-operative management strategy for blunt hepatic injuries. This procedure, however, is fraught with some possible serious complications. The success, as well as rate of complications of this procedure, is determined by degree and type of injury, hepatic anatomy and physiology, and embolization strategy among other factors. In this review, we discuss these important considerations to help shed further light on the contribution and impact of angioembolization with regards to complex hepatic injuries.

Download Full-text