Image-guided percutaneous gastrostomy in neonates with esophageal atresia

Background

Neonates with esophageal atresia may require a gastrostomy before definitive repair. Most surgeons do this procedure using the Stamm technique through a laparotomy. The authors describe a new technique for percutaneous placement of a gastrostomy in these infants and report their preliminary results.

Methods

For children with esophageal atresia and a tracheoesophageal fistula (TEF), the air-filled stomach is localized fluoroscopically and accessed using a standard percutaneous technique. For those with pure esophageal atresia, a transhepatic needle is used to instil air into the stomach. Once the stomach is distended, the gastrostomy tube is inserted under fluoroscopy.

Results

Fourteen neonates with esophageal atresia had a percutaneous gastrostomy tube placed. Eleven had esophageal atresia and a TEF, and 3 had pure esophageal atresia with a gasless abdomen requiring the transhepatic approach. There were no intraoperative or major postoperative complications, but there were 5 minor early postoperative complications and 2 minor late postoperative complications.

Conclusions

Percutaneous gastrostomy insertion is a safe technique for neonates with esophageal atresia and can be used even in children with pure esophageal atresia who have a gasless abdomen. This technique does not require laparotomy and appears to be associated with a low rate of complications.     

Prevention of gastroesophageal reflux using nissen fundoplication in the staged repair of esophageal atresia with distal tracheoesophageal fistula

To prevent the reflux of gastric contents into the bronchial tree through the tracheoesophageal fistula in patients with esophageal atresia with tracheoesophageal fistula, Nissen fundoplication was performed in the first-stage repair of staged operations. After elimination of the pulmonary complication, a correction of esophageal atresia and tracheoesophageal fistula was successfully performed through the extrapleural route at the age of 16 days. Thus, because Nissen fundoplication is simple to perform and effective in preventing gastroesophageal reflux, this procedure is considered to be useful in the staged repair of esophageal atresia with tracheoesophageal fistula.     

Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula: anesthetic and intensive care management of a series of eight neonates

Advances in minimally invasive techniques have made pediatric laparoscopic surgery commonplace. Thoracoscopic surgery in children however is still performed in only a few centers throughout the world. Between July 2001 and January 2004, the first eight esophageal atresia with tracheoesophageal fistula repairs were performed thoracoscopically at the Royal Hospital for Sick Children in Edinburgh. This article presents their anesthetic management, their postoperative management in the pediatric intensive care unit and reviews the complications seen in both the intraoperative and postoperative periods. Finally we discuss how our experience to date influences our perioperative management of these challenging cases.     

Supraclavicular approach to cervical esophageal atresia with tracheoesophageal fistula

This is a report of a patient with esophageal atresia with a blind upper pouch and a lower pouch fistula, both in the neck. The preoperative radiologic appearance of an air-filled esophagus behind the trachea suggested a higher than normal fistula. Preoperative bronchoscopy confirmed the cervical position of the fistula and, as a result, a supraclavicular incision was used to approach both the atresia and fistula.     

Long-term analysis of children with esophageal atresia and tracheoesophageal fistula

Background/purpose

For children with esophageal atresia (EA) or tracheoesophageal fistula (TEF), the first years of life can be associated with many problems. Little is known about the long-term function of children who underwent repair as neonates. This study evaluates outcome and late sequelae of children with EA/TEF.

Methods

Medical records of infants with esophageal anomalies (May 1972 through December 1990) were reviewed. Study parameters included demographics, dysphagia, frequent respiratory infections (> 3/yr), gastroesophageal reflux disease (GERD), frequent choking, leak, stricture, and developmental delays (weight, height < 25%, < 5%, respectively).

Results

Over 224 months, 69 infants (37 boys, 32 girls) were identified: type A, 10 infants; type B, 1; type C, 53; type D, 4; type E, 1. Mean follow-up was 125 months. During the first 5 years of follow-up, dysphagia (45%), respiratory infections (29%), and GERD (48%) were common as were growth delays. These problems improved as the children matured.

Conclusions

Children with esophageal anomalies face many difficulties during initial repair and frequently encounter problems years later. Support groups can foster child development and alleviate parent isolationism. Despite growth retardation, esophageal motility disorders, and frequent respiratory infections, children with EA/TEF continue to have a favorable long-term outcome.     

Early recognition and aggressive treatment of gastroesophageal reflux following repair of esophageal atresia

Twelve patients with gastroesophageal reflux following repair of esophageal atresia are presented. Reflux produced recurrent stricture, failure to thrive, repeated pneumonitis, and in one patient, respiratory arrest and nearly death. Treatment consists of positional therapy or fundoplication operation both of which seem less successful in this combination of lesions than with GER and a normal esophagus. There was one death as a late postoperative complication of fundoplication.     

Intentional tracheoesophageal fistula cannulation for gastric decompression in type C esophageal atresia

We describe a nonsurgical technique for managing gastric distention in infants with type C esophageal atresia, involving intubating the trachea with an umbilical catheter and entering the stomach through the fistula as soon as a flexible bronchoscope found its wide‐open orifice. This technique might have a special role when gastric distention precedes other commonly used preventive measures.     

Outcomes in esophageal atresia and tracheoesophageal fistula

Background/Purpose: The purpose of this analysis was to investigate outcomes in newborns with esophageal atresia (EA) or tracheoesophageal fistula (TEF) with respect to prognostic classifications and complications.Methods: Charts of all 144 infants with EA/TEF treated at British Columbia Children’s Hospital (BCCH) from 1984 to 2000 were reviewed. Patient demographics, frequency of associated anomalies, and details of management and outcomes were examined.Results: Applying the Waterston prognostic classification to our patient population, survival rate was 100% for class A, 100% for class B, and 80% for class C. The Montreal classification survival rate was 92% for class I and 71% for class II (P = .08). Using the Spitz classification, survival rate was 99% for type I, 84% for type II, and 43% for type III (P < .05). The Bremen classification survival rate was 95% “without complications” and 71% “with complications.” Complications included stricture (52%), gastroesophageal reflux (31%), anastomotic leakage (8%), recurrent fistula (8%), and pneumonia (6%). Seventeen patients underwent fundoplication for gastroesophageal reflux, 16 pre-1992 and one post-1992.Conclusions: Comparing the major prognostic classifications, the Spitz classification scheme was found to be most applicable. In our institution, the trend in management of gastroesophageal reflux after repair of EA/TEF has moved away from fundoplication toward medical management.     

Oral feeding outcomes in infants with esophageal atresia and tracheoesophageal fistula

Purpose

The purpose of this study was to explore oral feeding outcomes in infants born with type-C esophageal atresia and tracheoesophageal fistula (EA/TEF).

Lower esophageal sphincter dysfunction in esophageal atresia: nocturnal regurgitation and aspiration pneumonia

The association between lower esophageal sphincter (LES) incompetence, gastroesophageal reflux, and recurrent pneumonia in patients who have undergone successful repair of esophageal atresia (EA) and tracheoesophageal fistula is demonstrated in this study. The efficacy of esophageal manometric examination in the evaluation of the LES in young children after EA repair is documented. This study also provides evidence that infants and children with LES incompetence associated with EA may have LES responsiveness to bethanechol. Once established by manometry, this responsiveness may be used to manage the patient until surgical repair would be advantageous.     

An infrequent cause of misdiagnosis in esophageal atresia

Inability to pass an oral tube in infants with esophageal atresia often leads to the diagnosis of this anomaly. This report describes an infant with a delay in diagnosis resulting from initial passage of an oral tube through a distal tracheoesophageal fistula into the stomach.     

Neurodevelopmental outcomes of infants with esophageal atresia and tracheoesophageal fistula

Background

Esophageal atresia with or without tracheoesophageal fistula (EA/TEF) is a complex disorder, and most outcome data are confined to mortality and feeding-related morbidities. Our objective was to examine mortality, growth and neurodevelopmental outcomes in a large recent cohort of infants with EA/TEF.

A large single-institution review of tracheoesophageal fistulae with evaluation of the use of transanastomotic feeding tubes

Introduction

Transanastomatic feeding tube (TAT) use in the repair of tracheoesophageal fistulas (TEF) with or without esophageal atresia (EA) and EA with or without TEF allows for earlier enteral feedings, however, may predispose to esophageal stricture.