Chewing Function in Children with Repaired Esophageal Atresia–Tracheoesophageal Fistula

2017 ◽  
Vol 28 (06) ◽  
pp. 534-538 ◽  
Author(s):  
Selen Serel Arslan ◽  
Numan Demir ◽  
Aynur Karaduman ◽  
Feridun Tanyel ◽  
Tutku Soyer
Keyword(s):  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Primary Repair ◽  
Oral Feeding ◽  
Feeding Problems ◽  
Food Texture ◽  
Significant Difference ◽  
Level 3 ◽  
Level I ◽  
Chewing Disorder

Introduction Feeding problems are common in children with esophageal atresia and tracheoesophageal fistula (EA–TEF); however, chewing disorders, which may cause inability to intake solid food, have not been evaluated. Therefore, we aimed to evaluate the chewing function in children with repaired EA–TEF. Materials and Methods Age, sex, the type of atresia, the type of repair, and the time to start oral feeding were recorded. The level of the chewing performance was scored according to the Karaduman Chewing Performance Scale (KCPS). The International Dysphagia Diet Standardization Initiative (IDDSI) was used to determine the tolerated food texture in children. Results A group of 30 patients were included, of which 53.3% was male. The percentages of the isolated-EA and that of the EA–distal TEF were 40% and 60%, respectively. The median value for the time to start oral feeding was 4.5 weeks (min = 1, max = 72). Eleven (36.7%) children had chewing disorder. The KCPS scores showed level I in six cases, level III in four cases, and level IV in one case. Five children with chewing disorder had IDDSI level 3 and six had level 7, along with the sensation of stuck food. We found no significant difference between the KCPS scores according to the repair type (p = 0.07). The median values of the KCPS scores of children with primary repair, delayed repair, and colon interposition were 0 (min = 0, max = 4), 0.5 (min = 0, max = 3), 2 (min = 0, max = 3), respectively. A significant positive correlation was found between the time to start oral feeding and the KCPS scores (r = 0.63, p = 0.001). Conclusion Chewing disorders can be observed in children with EA–TEF, and the type of repair and the delay in oral feeding may be related to chewing disorder. Therapeutic maneuvers are needed to improve the chewing function in children with EA–TEF.

DOZ047.45: The effect of transanastomotic feeding tubes on anastomotic strictures following esophageal atresia repair

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
K LaRusso ◽  
R Lakabi ◽  
D Lévesque ◽  
J-M Laberge ◽  
S Emil
Keyword(s):  
Esophageal Atresia ◽  
Primary Repair ◽  
Hospital Length ◽  
Oral Feeding ◽  
Hospital Length Of Stay ◽  
Stricture Formation ◽  
Type D ◽  
Anastomotic Strictures ◽  
Significant Difference ◽  
One Year

Abstract Purpose Recent studies have identified the use of transanastomotic tubes (TATs) as an independent risk factor for the development of strictures after repair of esophageal atresia (EA). We retrospectively analyzed a 25-year cohort of EA patients (1993–2018) to investigate the effect of TAT use on stricture formation. Methods Following institutional approval (MP-37–2019-2991), a retrospective study of all Type C and Type D EA patients who underwent primary repair was examined. Infants were included if they had surgery within the first two weeks of life and had a least one year of follow-up. Stricture was defined as the presence of symptoms confirmed by imaging and/or endoscopy. A multiple logistic regression model was used to compare stricture in those with and without TATs. Poisson regression was used to evaluate differences in postoperative outcomes listed in Table 1. Results Strictures occurred in 35 of 85 patients (41%). Of those with strictures, 25 (71%) had transanastomotic tubes. There was no significant difference in stricture rates between those with TATs and without TATs (odd ratio (OR) = 1.94, 95% confidence interval (CI): 0.78–5.06, P = 0.161). However, those who had TATs had a significantly higher number of dilations overall (rate ratio (RR) = 1.47, 95% CI: 1.09–2.03, P = 0.014). In patients with TATs, the time to enteral feeding was significantly shorter (RR = 0.37, 95% CI: 0.28–0.49, P < 0.001), but the time to oral feeding was significantly longer (RR = 1.37, CI: 1.20–1.56, P < 0.001). The TAT group had a 34% lower mean hospital length of stay. On multivariate analysis, there remained no difference in stricture rates between the two groups. Conclusion Transanastomotic tubes do not seem to result in increased strictures rates in our cohort, but significantly decrease time to initiation of enteral feeds and reduce the duration of hospital stay.

DOZ047.03: The functional chewing training for chewing dysfunction in children with repaired esophageal atresia–tracheoesophageal fistula

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
S S Arslan ◽  
N Demir ◽  
A Karaduman ◽  
F C Tanyel ◽  
T Soyer
Keyword(s):  
Food Intake ◽  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Holistic Approach ◽  
Solid Food ◽  
Food Texture ◽  
Baseline Evaluation ◽  
Level 3 ◽  
Level 1 ◽  
Performance Scale

Abstract Introduction Chewing disorders (CD) may cause restrictions in solid food intake and can be seen in 37% of children with esophageal atresia–tracheoesophageal fistula (EA-TEF).1 The Functional Chewing Training (FuCT) is a holistic approach to improve chewing function (CF) in children. The study aimed to evaluate the effects of FuCT on CF in children with EA-TEF. Materials and Methods Twenty children with CD were included. Patients received 12 weeks of FuCT, including impairment-based and adaptive components. Chewing performance level was scored with the Karaduman Chewing Performance Scale (KCPS), and tolerated food texture was determined by the International Dysphagia Diet Standardization Initiative (IDDSI). The baseline and final levels of KCPS and IDDSI were compared to evaluate the effects of FuCT on CF. Results 45% of cases were isolated-EA and 55% were EA-distal TEF with a median age of 31 (min = 25, max = 84) months, of which 65% (n = 13) were male. Baseline evaluation showed that 12 cases were in level-1, 6 cases in level-3 and 2 cases in level-4 according to the KCPS. Eight children with CD (40%) had IDDSI level-3 and 12 (60%) had level-7. There was a significant improvement in KCPS scores and IDDSI scores after 12 weeks of training (P < 0.01, P = 0.005, respectively). KCPS scores showed level-0 in 15 cases, and level-1 in 5 cases. All children had IDSSI level-7. Conclusions The FuCT is an effective method to improve chewing function in children EA-TEF who had CD.

scholarly journals Efficacy of a standardized tube weaning program in pediatric patients with feeding difficulties after successful repair of their esophageal atresia/tracheoesophageal fistula

2020 ◽  
Vol 179 (11) ◽  
pp. 1729-1737
Author(s):  
Sabine Marinschek ◽  
Karoline Pahsini ◽  
Victor Aguiriano-Moser ◽  
Marion Russell ◽  
Barbara Plecko ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Primary Anastomosis ◽  
Oral Feeding ◽  
Feeding Problems ◽  
Feeding Difficulties ◽  
Long Gap ◽  
Tube Weaning ◽  
Tube Dependency ◽  
Graz Model

Abstract Children born with esophageal atresia (EA) might suffer from significant oral feeding problems which could evolve into tube dependency. The primary aim of the study was to define the outcome of tube weaning in children after successful EA repair and to compare outcomes in children with short gap/TEF (tracheoesophageal fistula) and long-gap EA. Data of 64 children (28 with short-gap EA/TEF with primary anastomosis and 36 with long-gap EA with delayed surgical repair) who participated in a standardized tube weaning program based on the “Graz model of tube weaning” (in/outpatients in an intensive 3-week program, online coaching (Netcoaching) only, or a combined 2-week intensive onsite followed by online treatment “Eating School”) from 2009 to 2019 was evaluated. Sixty-one patients completed the program by transitioning to exclusive oral intake (95.3%). Three children (4.7%) were left partially weaned at the time of discharge. No significant differences could be found between short gap/TEF and long-gap EA group regarding outcomes. Conclusions: The study’s findings support the efficacy of tube weaning based on the published “Graz model of tube weaning” for children born with EA/TEF and indicate the necessity of specialized tube weaning programs for these patients. What is Known:• Children with esophageal atresia/tracheoesophageal fistula often suffer from feeding problems and tube dependency.• Different tube weaning programs and outcomes have been published, but not specifically for children with EA. What is New:• Evaluation of a large sample of children referred for tube weaning after EA repair.• Most children with EA can be weaned off their feeding tubes successfully after attending a specialized tube weaning program.

Novel approach for the dissection of upper pouch during primary repair of esophageal atresia with tracheoesophageal fistula: Technique and results

2020 ◽  
Vol 55 (4) ◽  
pp. 767-771
Author(s):  
Vaibhav Pandey ◽  
Pranay Panigrahi ◽  
Rakesh Kumar ◽  
Arj Deo Upadhyayay ◽  
Shiv P Sharma
Keyword(s):  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Primary Repair ◽  
Novel Approach

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

2017 ◽  
Vol 52 (10) ◽  
pp. 1567-1570 ◽  
Author(s):  
Andreas Schmidt ◽  
Florian Obermayr ◽  
Justus Lieber ◽  
Christian Gille ◽  
Frank Fideler ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Very Low Birth Weight ◽  
Primary Repair ◽  
Low Birth Weight Infants

scholarly journals Intra-Operative Total Bowel Washing: A New Method to Improve the Outcome of Gastroschisis Primary Repair

2020 ◽  
Vol 30 (3) ◽  
Author(s):  
Ahmad Mohammadipour ◽  
Mehran Hiradfar ◽  
Reza Shojaeian
Keyword(s):  
Gastrointestinal Tract ◽  
Abdominal Wall ◽  
Abdominal Wall Defect ◽  
Primary Repair ◽  
Abdominal Cavity ◽  
Abdominal Wall Reconstruction ◽  
Operation Time ◽  
Oral Feeding ◽  
Main Challenge ◽  
Significant Difference

Background: Gastroschisis is an abdominal wall defect that is managed by surgical reduction of herniated bowel into the abdominal cavity and abdominal wall reconstruction. Loss of abdominal domain is the main challenge that may complicate the process of gastroschisis management. Objectives: This article is about innovative manure called total bowel washing (TBW) that may improve the outcome of gastroschisis primary repair. Methods: All neonates with gastroschisis who met the study inclusion criteria between 2006 - 2019 were enrolled and divided into two groups of conventional and TBW method of gastroschisis management. In TBW group, bowls were washed with warm saline and after a gentle enterolysis, the whole gastrointestinal tract was irrigated via a gastric tube and evacuated completely from thick meconium until the watery stool started to come out of anus slightly. Primary abdominal wall closure was performed after loop by loop bowel reduction. Gastroschisis management outcome was compared between the two groups. Results: 15 neonates were allocated in each group. Demographic and anthropometric variables were compared and any significant difference wasn’t reported between the two groups. We observed a significantly better outcome in terms of faster GI rehabilitation, shorter time to oral feeding tolerance, less need to silo placement and shorter NICU and hospital stay in TBW method. Operation time was slightly longer in TBW group while the difference was not significant statistically. Conclusions: Total bowel washing and complete evacuation of gastrointestinal tract from thick meconium will increase the success rate of primary repair and improve the outcome of gastroschisis management.

Thoracoscopic surgery for recurrent tracheoesophageal fistula after esophageal atresia repair

2020 ◽  
Vol 33 (9) ◽  
Author(s):  
Kaiyun Hua ◽  
Shen Yang ◽  
Yanan Zhang ◽  
Yong Zhao ◽  
Yichao Gu ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Thoracoscopic Surgery ◽  
Operation Time ◽  
Oral Feeding ◽  
Uneventful Recovery ◽  
Severe Malnutrition ◽  
Z Score

Summary We aimed to investigate the safety, feasibility, and outcomes of thoracoscopic surgery for recurrent tracheoesophageal fistula (rTEF) after esophageal atresia repair. The medical records and follow-up data of 31 patients who underwent thoracoscopic surgery for rTEF at a single institution were collected and reviewed. In total, 31 patients were enrolled with a median age of 7 months (range: 3–30 months) and a median weight of 6,000 g (range: 4,000–12,000 g) before reoperation. The median operation time for the entire series was 2.9 hours (range: 1.5–7.5 hours), and the median total hospitalization duration after surgery was 19 days (range: 11–104 days). One patient died of anastomotic leakage, a second rTEF, severe malnutrition, and thoracic infection; the mortality rate was 3.23% (1/31). Nine patients (9/31, 29.03%) had an uneventful recovery, and the incidences of postoperative anastomotic leakage, anastomotic stricture, and second rTEF were 25.81%, 61.29%, and 9.68%, respectively. After a median follow-up of 12 months (range: 3–24 months), 26 survivors resumed full oral feeding, 2 were tube fed, 2 required a combination of methods, and 4 patients experienced severe respiratory complications. In total, 9 patients had pathological gastroesophageal reflux, and 2 patients eventually underwent Nissen fundoplication. Of the 30 survivors with growth chart data, the median weight for age Z-score, height for age Z-score, and weight for height Z-score were − 0.46 (range: −5.1 to 2.8), 0.75 (range: −2.7 to 4.7), and − 1.14 (range: −6.8 to 3.0), respectively. Thoracoscopic surgical repair for rTEF is safe, feasible, and effective with acceptable mortality and morbidity.

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