Initial Experience with Thoracoscopic Esophageal Atresia and Tracheoesophageal Fistula Repair: Lessons Learned and Technical Considerations to Achieve Success

2015 ◽  
Vol 81 (3) ◽  
pp. 268-272
Author(s):  
Daniel K. Robie
Keyword(s):  
Length Of Stay ◽  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Operative Time ◽  
Lessons Learned ◽  
Type D ◽  
Minimally Invasive Surgical ◽  
Expected Length ◽  
Stability Type

The minimally invasive surgical (MIS) repair of esophageal atresia/tracheoesophageal fistula (EA/ TEF) is challenging and requires advanced endoscopic skills. The purpose of this study was to provide insight in successfully introducing the MIS repair based on the initial cases performed by a single pediatric surgeon and review of the experience of others. A retrospective review of all MIS TEF repairs performed by a single surgeon was conducted. Data gathered included patient demographics, technical details of repair including operative time, short- and long-term postoperative morbidity, length of stay, and follow-up. Eight cases (seven Type C, one Type D) were selected for MIS repair based on the judgment of the surgeon with consideration of adequate patient size, stability, type of associated anomalies, and expected length of esophageal gap. Operative time was an average of 207 minutes and there was one conversion to open for successful repair. There were no leaks and only one patient required a single anastomotic dilation at 19 months of age. There were two postoperative pneumothoraces of which one required bronchoscopic laser fistula ablation. Length of stay was an average of 16 days and length of follow-up is a median of 219 days. MIS repair of EA/TEF can be done successfully but requires careful patient selection, advanced MIS skills and meticulous attention to operative technique.

scholarly journals Clinical Comparison Between Thoracoscopic and Thoracotomy Repair of Gross Type C Esophageal Atresia

2021 ◽  
Author(s):  
Shen Yang ◽  
Peize Wang ◽  
Zhi Yang ◽  
Siqi Li ◽  
Junmin Liao ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Anastomotic Leakage ◽  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Operative Time ◽  
Anastomotic Stricture ◽  
Surgical Approaches ◽  
Invasive Technique ◽  
Thoracoscopic Approach ◽  
Type C

Abstract Background To compare the clinical outcomes between thoracoscopic approach and thoracotomy surgery in patients with Gross type C Esophageal atresia (EA) and tracheoesophageal fistula (TEF). Methods Patients with Gross type C EA/TEF who underwent surgery from January 2007 to January 2020 at Beijing Children’s Hospital were retrospectively analyzed. The patients were divided into 2 groups according to surgical approaches. The perioperative factors and postoperative complications were compared among the 2 groups. Results One hundred and ninety patients (132 boys and 58 girls) with a median birth weight of 2975 (2600, 3200) g were included. The primary operations were performed via thoracoscopic (n = 62) and thoracotomy (n = 128) approach. After comparison of clinical characteristics between the 2 groups, we found that there were statistically significant differences in associated anomalies, method of fistula closure, duration of mechanical ventilation after surgery, feeding option before discharge, management of pneumothorax, and prognosis (all P < 0.05). To a certain extent, thoracoscopic surgery reduced the incidence of anastomotic leakage and increased the incidence of anastomotic stricture in this study. However, there were no statistically significant differences between the 2 groups in terms of operative time, postoperative pneumothorax, anastomotic leakage, anastomotic stricture, and recurrent tracheoesophageal fistula (all P > 0.05). Conclusions Thoracoscopy surgery for Gross type C EA/TEF is a safe and effective, minimally invasive technique with comparable operative time and incidence of postoperative complications.

scholarly journals ESOPHAGEAL ATRESIA WITH DISTAL TRACHEOESOPHAGEAL FISTULA: SURGERY TREATMENT AND A LONG TERM FOLLOW UP

2012 ◽  
Vol 4 (1) ◽  
pp. 32 ◽  
Author(s):  
E. Cerchia ◽  
F. Molinaro ◽  
M. Pavone ◽  
E. Bindi ◽  
R. Angotti ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Fistula Surgery ◽  
Long Term Follow Up

scholarly journals ESOPHAGEAL ATRESIA WITH DISTAL TRACHEOESOPHAGEAL FISTULA: SURGERY TREATMENT AND A LONG TERM FOLLOW UP

2013 ◽  
Vol 4 (1) ◽  
Author(s):  
E. Cerchia ◽  
F. Molinaro ◽  
M. Pavone ◽  
E. Bindi ◽  
R. Angotti ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Fistula Surgery ◽  
Long Term Follow Up

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.

Management of recurrent tracheoesophageal fistula after esophageal atresia and follow-up

2017 ◽  
Vol 30 (9) ◽  
pp. 1-8 ◽  
Author(s):  
J. Wang ◽  
M. Zhang ◽  
W. Pan ◽  
W. Wu ◽  
W. Yan ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Tracheoesophageal Fistula

scholarly journals ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: Follow-up and Framework

2019 ◽  
Vol 30 (06) ◽  
pp. 475-482 ◽  
Author(s):  
Carmen Dingemann ◽  
Simon Eaton ◽  
Gunnar Aksnes ◽  
Pietro Bagolan ◽  
Kate M. Cross ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Primary Anastomosis ◽  
Consensus Conference ◽  
Reference Network ◽  
Pediatric Gastroenterology ◽  
Treatment Protocols ◽  
The North ◽  
Consensus Statements

Abstract Introduction Improvements in care of patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) have shifted the focus from mortality to morbidity and quality-of-life. Long-term follow-up is essential, but evidence is limited and standardized protocols are scarce. Nineteen representatives of the European Reference Network for Rare Inherited Congenital Anomalies (ERNICA) from nine European countries conducted a consensus conference on the surgical management of EA/TEF. Materials and Methods The conference was prepared by item generation (including items of surgical relevance from the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN)-The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines on follow-up after EA repair), item prioritization, formulation of a final list containing the domains Follow-up and Framework, and literature review. Anonymous voting was conducted via an internet-based system. Consensus was defined as ≥75% of those voting with scores of 6 to 9. Results Twenty-five items were generated in the domain Follow-up of which 17 (68%) matched with corresponding ESPGHAN-NASPGHAN statements. Complete consensus (100%) was achieved on seven items (28%), such as the necessity of an interdisciplinary follow-up program. Consensus ≥75% was achieved on 18 items (72%), such as potential indications for fundoplication. There was an 82% concordance with the ESPGHAN-NASPGHAN recommendations. Four items were generated in the domain Framework, and complete consensus was achieved on all these items. Conclusion Participants of the first ERNICA conference reached significant consensus on the follow-up of patients with EA/TEF who undergo primary anastomosis. Fundamental statements regarding centralization, multidisciplinary approach, and involvement of patient organizations were formulated. These consensus statements will provide the cornerstone for uniform treatment protocols and resultant optimized patient care.

scholarly journals Endoscopic Stenting and Clipping for Anastomotic Stricture and Persistent Tracheoesophageal Fistula after Surgical Repair of Esophageal Atresia in an Infant

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Mohammed Amine Benatta ◽  
Amine Benaired ◽  
Ahmed Khelifaoui
Keyword(s):  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Surgical Repair ◽  
Anastomotic Stricture ◽  
Balloon Dilation ◽  
Endoscopic Stenting ◽  
Recurrent Fistula ◽  
Metal Type ◽  
Esophageal Strictures

Anastomotic stricture (AS) and recurrent tracheoesophageal fistula (TEF) are two complications of surgical repair of esophageal atresia (EA). Therapeutic endoscopic modalities include stenting, tissue glue, and clipping for TEF and endoscopic balloon dilation bougienage and stenting for esophageal strictures. We report herein a two-month infant with both EA and TEF who benefited from a surgical repair for EA, at the third day of life. Two months later he experienced deglutition disorders and recurrent chest infections. The esophagogram showed an AS and a TEF confirmed with blue methylene test at bronchoscopy. A partially covered self-expanding metal type biliary was endoscopically placed. Ten weeks later the stent was removed. This allows for easy passage of the endoscope in the gastric cavity but a persistent recurrent fistula was noted. Instillation of contrast demonstrated a fully dilated stricture but with a persistent TEF. Then we proceeded to placement of several endoclips at the fistula site. The esophagogram confirmed the TEF was obliterated. At 12 months of follow-up, he was asymptomatic. Stenting was effective to alleviate the stricture but failed to treat the TEF. At our knowledge this is the second case of successful use of endoclips placement to obliterate recurrent TEF after surgical repair of EA in children.

scholarly journals Impact of drainage technique on pediatric pyeloplasty: Comparative analysis of externalized uretero-pyelostomy versus double-J internal stents

2015 ◽  
Vol 9 (7-8) ◽  
pp. 453 ◽  
Author(s):  
Linda C. Lee ◽  
Niki Kanaroglou ◽  
Joseph M. Gleason ◽  
Joao L. Pippi Salle ◽  
Darius J. Bägli ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Complication Rate ◽  
Operative Time ◽  
Small Sample Size ◽  
Small Sample ◽  
Safe Alternative ◽  
Urinary Drainage ◽  
Dj Stent ◽  
The Mean

Introduction: Pediatric pyeloplasty with double J (DJ) stent drainage requires manipulation of the uretero-vesical junction (UVJ) and a second anesthetic for removal. Externalized uretero-pyelostomy (EUP) stents avoid these issues. We report outcomes of laparoscopic and open pyeloplasty with EUP compared to DJ stents in children.Methods: We retrospectively reviewed 76 consecutive children who underwent pyeloplasty for ureteropelvic junction (UPJ) obstruction over a 1-year period by 5 pediatric urologists at a single institution. The exclusion criteria included patients with concomitant urological procedures, other urinary drainage strategies, “stentless” pyeloplasty or patients without follow-up data. Based on surgeon preference, 24 patients had a EUP stent and 38 had a DJ stent placed.Results: The mean follow-up was 23.8 ± 10.9 months and 21.1 ± 11.1 months for the EUP and DJ stent groups, respectively (p = 0.32). The mean age was 40 ± 54 months and 80 ± 78 months for the EUP and DJ groups, respectively (p = 0.04). The EUP group had a greater proportion of open pyeloplasties (n = 17, 71%) versus the DJ group (n = 16, 42%; p = 0.04). There were no statistically significant differences in operative time, length of stay, and overall complication rate between groups. Complications were divided by timing of complication (intraoperative, before and after 3 months) and according to the Clavien Classification system. There were no statistically significant differences between these subgroups. The limitations of this study include small sample size, potential selection bias, and heterogeneity between both study groups.Conclusions: Pyeloplasty using EUP stents does not incur prolonged operative time, longer length of stay or higher complication rate when compared to DJ stents. Within the limitations of this study, EUP stents may be a safe alternative to DJ stents.

scholarly journals Early promising result of bicompartmental knee replacement in middle-aged patients

2019 ◽  
Vol 26 (2) ◽  
pp. 85-88
Author(s):  
Bruce Yan Ho Tang ◽  
Chi Nok Cheung ◽  
Hon For Tsui ◽  
Hok Leung Wong
Keyword(s):  
Length Of Stay ◽  
Knee Replacement ◽  
Operative Time ◽  
Knee Score ◽  
Middle Aged ◽  
Aged Patients ◽  
Incision Length ◽  
The Mean ◽  
Hemoglobin Drop

Introduction: Partial knee replacement (PKR) is one of the treatment options in middle-aged patients with less extensive knee osteoarthritis, with unicompartmental knee replacement (UKR) most commonly done for medial osteoarthritis. There are numerous advantages like bone/ligament preserving and faster recovery. However, the indications of UKR remain controversial, as most patients have some patellofemoral joint (PFJ) osteoarthritis. We performed modular bicruciate-retaining bicompartmental knee replacement (BKR) in this group of patients and compared the outcome with total knee replacement (TKR). Materials and Methods: From 2016 to 2017, 14 BKR were performed in patients with medial and PFJ osteoarthritis. They were retrospectively compared with 14 TKR performed in patients with similar age and severity. The incision length, operative time, blood loss (in terms of hemoglobin drop), and length of stay were recorded. Pre- and postoperative range of motion and Knee Society knee score at 1-year follow-up were compared. Results: The mean incision length for BKR was shorter than TKR (130.1 vs. 185.1 mm), but the mean operative time was also longer (152.6 vs. 88.1 min). There was also less mean hemoglobin drop (1.8 vs. 2.6 g/dL) and shorter length of stay (7.4 vs. 9.2 days). The mean postoperative function score is better in BKR group (90.4 vs. 77.5), and the mean postoperative knee score (87.2 vs 88.9) and flexion (115.7° vs. 111.4°) were similar for both groups. Discussion: In selected patients, BKR is a good alternative to TKR. It preserves advantages of UKR while also tackle the PFJ which is the most controversial aspect of UKR. The early clinical outcome in our study is promising. However, there is a learning curve. Longer follow-up is necessary to study on the performance and survivorship as compared with UKR and TKR.

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