Strategies for optimizing surgical outcome in patients with esophageal atresia with tracheo-esophageal fistula

Authors

  • Rajashekhar T. Patil Department of Surgery, S. Nijalingappa Medical College, Bagalkot, Karnataka, India
  • Advait Prakash Department of pediatric surgery, Sri Aurobindo Institute of medical Sciences, Indore, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20171625

Keywords:

Esophageal atresia, Pleural flap wrap, Tracheo-esophageal fistula, Ventilator support

Abstract

Background: There have been major advances in the surgery for esophageal atresia (EA) and tracheo-esophageal fistula (TEF) with survival now exceeding 90%. The standard open approach to EA and distal TEF has been well described and essentially unchanged in last 60 years. Improved survival in recent decades is most attributable to advances in neonatal surgical techniques, anaesthesia and perioperative care. In a prospective randomized trial, we analysed the effect of pleural flap wrap around the anastomosis and post-operative elective ventilation support for 48 hours as main strategies towards improving the outcome in such patients.

Methods: Twenty five neonates who were diagnosed as a case on tracheo-esophageal fistula (TEF) on clinical and radiological basis were selected for the study. All babies were more than 2kg weight and were operated within first two days of life after optimization. There was no evidence of any congenital heart disease or any other associated anomaly. In all patients primary esophageal anastomosis was possible which was subsequently covered by pleural flap wrap. All the patients were put post-operatively on ventilator electively for 48 hours. Contrast study was done on post-operative day five and feeding was started subsequently.

Results: Postoperative surgical outcome was very good. Out of twenty five cases, 24 patients survived and only one baby died secondary to anastomotic leak and sepsis. Twenty three babies were discharged on post-operative day 8. One baby was on ventilator for 6 days and discharged on postoperative day 15. All patients are on regular follow up.

Conclusions: Surgical outcome in patients with esophageal atresia and tracheo-esophageal fistula in neonates can be improved with use of pleural flap wrap and elective post-operative ventilation.

References

Catalano P, Di Pace MR, Caruso AM, Salerno S, Cimador M. A simple technique of oblique anastomosis can prevent stricture formation in primary repair of esophageal atresia. J Pediatr Surg. 2012;47(9):1767-71.

Melek M, Cobanoglu U. A new technique in primary repair of congenital esophageal atresia preventing anastomotic stricture formation and describing the opening condition of blind pouch: plus (“+”) incision. Gastroenterol Res Pract. 2011;(11):1-4.

Upadhyaya VD, Gangopadhyaya AN, Gupta DK, Sharma SP, Kumar V. Prognosis of congenital tracheoesophageal fistula with esophageal atresia on the basis of gap length. Pediatr Surg Int. 2007;23(8):767-71.

McKinnon LJ, Kosloske M. Prediction and prevention of anastomotic complications of esophageal atresia and tracheoesophageal fistula. J Pediatr Surg. 1990;25(7):778-81.

Sharma AK, Shekhawat NS, Agrawal LD, Chaturvedi V, Kothari SK. Esophageal atresia and tracheoesophageal fistula: a review of 25 years’ experience. Pediatr Surg Int. 2000;16(7):478-82.

Gross RE, Scott HW. Correction of esophageal atresia and tracheo-esophageal fistula by closure of fistula and oblique anastomosis of esophageal segments. Surg Gynecol Obstet. 1946;82:518-27.

Touloukian RJ, Pickett LK, Spackman T, Biancani P. Repair of esophageal atresia by end-to-side anastomosis and ligation of the tracheoesophageal fistula: A critical review of 18 cases. J Pediatr Surg. 1974;9(3):305-10.

Touloukian RJ. Long-term results following repair of esophageal atresia by end-to-side anastomosis and ligation of the tracheoesophageal fistula. J Pediatr Surg. 1981;16(6):983-8.

Singh SJ, Shun A. A new technique of anastomosis to avoid stricture formation in oesophageal atresia. Pediatr Surg Int. 2001;17(7):575-7.

Sharma AK, Shukla AK, Prabhakar GI, Sarin YK, Sharma CS. Esophageal atresia: tragedies and triumphs over two decades in a developing country. Int Surg. 1993;78(4):311-4.

Lilja HE, Wester T. Outcome in neonates with esophageal atresia treated over the last 20 years. Pediatr Surg Int. 2008;24(5):531-6.

Schultz LR, Clatworthy HW. Esophageal strictures after anastomosis in esophageal atresia. Arch Surg. 1963;87(1):120-4.

Tandon RK, Khan TR, Maletha M, Rawat JD, Wakhlu A. Modified method of primary esophageal anastomosis with improved outcome in cases of esophageal atresia with tracheoesophageal fistula. Pediatr Surg Int. 2009;25(4):369-72.

Soumyodhriti G, Kumar MA, Arvind S, Pratap SA. Congenital tracheo esophageal fistula repair, a modified technique of anastomosis using pleural flap. J Pediatr Neonat Care. 2017;6(1):234.

Al-Salem AH, Qaisaruddin S, Srair HA, Dabbous IA, Al-Hayek R. Elective post-operative ventilation in the management of esophageal atresia and tracheoesophageal fistula. Pediatr Surg Int. 1997;12(4):261-3.

Downloads

Published

2017-04-22

Issue

Section

Original Research Articles