Effect of muscle relaxants on the prognosis of neonates with congenital esophageal atresia-tracheoesophageal fistula after surgery / 中国当代儿科杂志

OBJECTIVE@#To summarize the experience in the application of muscle relaxants in the perioperative period in neonates with congenital esophageal atresia-tracheoesophageal fistula (EA-TEF).@*METHODS@#A retrospective analysis was performed on the medical data of 58 previously untreated neonates with EA-TEF who were treated in the Neonatal Center of Beijing Children's Hospital, Capital Medical University from 2017 to 2019. The incidence rate of anastomotic leak was compared between the neonates receiving muscle relaxants for different durations after surgery (≤ 5 days and > 5 days). The correlation between the duration of postoperative use of muscle relaxants and the duration of mechanical ventilation was evaluated.@*RESULTS@#Among the 58 neonates with EA-TEF, 44 underwent surgery, among whom 35 with type III EA-TEF underwent thoracoscopic surgery. Among these 35 neonates, 30 (86%) received muscle relaxants after surgery, with a median duration of 4.75 days, and 6 (18%) experienced anastomotic leak. There was no significant difference in the incidence rate of anastomosis leak between the ≤ 5 days and > 5 days groups (@*CONCLUSIONS@#Prolonged use of muscle relaxants after surgery cannot significantly reduce the incidence of anastomotic leak, but can prolong the duration of invasive mechanical ventilation in neonates with EA-TEF. Therefore, prolonged use of muscle relaxants is not recommended after surgery.

Características clínico-quirúrgicas de la atresia esofágica en el Instituto Nacional de Salud del Niño San Borja, Lima, Perú. 2015-2017 / Clinical-surgical characteristics of esophageal atresia in the National Institute of Children's Health San Borja, Lima, Peru. 2015-2017

RESUMEN Objetivo : Describir las características clínico-quirúrgicas y sociodemográficas de pacientes con atresia esofágica (AE) del Instituto Nacional de Salud del Niño San Borja (INSN-SB) 2015-2017. Material y métodos : Estudio observacional descriptivo de casos con AE 2015-2017. Los datos se procesaron y analizaron en el programa SPSS v20, las variables cualitativas fueron expresadas en frecuencias absolutas y relativas. Resultados : Se analizaron 74 casos con AE, 55,4% (n=41) fueron de sexo masculino. Según edad gestacional 45 a término, 28 pre-término y un post-término. El 59,5% tuvieron peso adecuado al nacer. 28,4% tuvieron control prenatal (CPN) completo y 68,9% no tuvieron diagnóstico prenatal de AE. La atresia con fistula traqueo-esofágica (FTE) distal fue la más frecuente con 74,3% (n=55). Se presentó sialorrea en 55 pacientes (74,3%) y disnea en 54 (72,9%). Predominaron las malformaciones cardiacas en el 27,1%, seguida por digestivas 20,3% y genitourinarias 17,6%. Solo 26 tuvieron síndromes asociados, VACTERL en 12 casos. La anastomosis termino-terminal y cierre de fistula se realizó en 55 pacientes (74,3%). 48 presentaron complicaciones tempranas, predominando sepsis (20,3%) y 46 complicaciones tardías, siendo reflujo gastroesofágico el más frecuente 29,7%. La mortalidad fue 10,8%. Conclusiones : La mayoría fue de sexo masculino, a término, con adecuado peso al nacer y sin CPN. La AE con FTE distal fue la más frecuente. Sialorrea y disnea fueron los síntomas predominantes y malformaciones cardiacas y digestivas las más asociadas. La anastomosis término-terminal y cierre de fístula fue la técnica más frecuente, como complicaciones sepsis y reflujo gastroesofágico. La mortalidad fue baja.

ABSTRACT Objective : Describe the clinical-surgical and sociodemographic characteristics of patients with esophageal atresia (EA) of the Instituto Nacional de Salud del Niño San Borja (INSN-SB) during 2015-2017. Material and methods : Descriptive observational study of cases with EA 2015-2017. The data was processed and analyzed in the SPSS v20 program, the absolute and relative frequency distributions were expressed in tables. Results : 74 cases with AE were analyzed, 55.4% (n=41) were male. According to gestational age, 45 were at term, 28 pre-term and one post-term. 59.5% had adequate weight at birth. Only 28.4% had complete prenatal care (CPN). 68.9% did not have a prenatal diagnosis of AE. Atresia with distal tracheoesophageal fistula (TEF) was the most frequent in 74.3% (n=55). Hypersalivation occurred in 55 patients (74.3%), followed by dyspnea in 54 (72.9%). Cardiac malformations predominated in 27.1%, followed by digestive 20.3% and genitourinary 17.6%. Only 26 had associated syndromes, VACTERL in 12 cases. End-to-end anastomosis and fistula closure were performed in 55 patients (74.3%). 48 presented early complications, predominating sepsis (20.3%) and 46 late complications, with gastroesophageal reflux being the most frequent 29.7%. Regarding mortality, 8 (10.8%) died. Conclusions : Most of the cases were male, at term, with adequate weight at birth and without CPN. AE with distal TEF was the most frequent. Sialorrhea and dyspnea were the predominant symptoms and cardiac and digestive malformations the most associated. End-to-end anastomosis surgery and fistula closure was the most frequent technique. Complications were sepsis and gastroesophageal reflux. Mortality was low.

Fístula traqueoesofágica en H en el período neonatal: dificultades en el diagnóstico y diferentes abordajes terapéuticos. Serie de casos / H-type tracheoesophageal fistula in neonatal period: Difficulties in diagnosis and different treatment approaches. A case series

La fístula traqueoesofágica congénita sin atresia esofágica asociada, conocida como tipo H, es una anomalía infrecuente. Se manifiesta con episodios de tos, ahogo y cianosis durante la alimentación y/o neumonía recurrente.Si bien los síntomas están usualmente presentes desde el nacimiento, el diagnóstico es difícil. La rareza de esta patología, los síntomas no específicos y las limitaciones en la demostración radiológica y endoscópica de la fístula contribuyen, a menudo, a la demora entre la presentación y la confirmación del diagnóstico.Se describen las manifestaciones clínicas, los métodos de evaluación y el tratamiento de 3 neonatos con esta patología, y se presentan recomendaciones para el diagnóstico a fin de evitar demoras innecesarias en el manejo de las fístulas en H.

Congenital tracheoesophageal fistula not associated with esophageal atresia, known as H-type fistula, is an uncommon anomaly. It presents with cough, choking, and cyanosis during feeding and/or recurrent pneumonia. Although symptoms are usually present from birth, diagnosis is difficult. The rarity of this disease, non-specific symptoms, and the limitations of radiological and endoscopic confirmation of the fistula often result in a delay between presentation and diagnosis confirmation. Here we describe the clinical manifestations, assessment methods, and management of 3 newborn infants with H-type tracheoesophageal fistula, together with diagnosis recommendations to prevent unnecessary delays in the management of this condition.

Treatment of large persistent tracheoesophageal peristomal fistulas using silicon rings / Tratamento de fístula periestomal traqueoesofágica grande e persistente com anéis de silicone

Abstract Introduction: Tracheoesophageal peristomal fistulae can often be solved by reducing the size of the fistula or replacing the prosthesis; however, even with conservative techniques, leakage around the fistula may continue in total laryngectomy patients. Also, several techniques have been developed to overcome this problem, including injections around the fistula, fistula closure with local flaps, myofascial flaps, or free flaps and fistula closure using a septal perforation silicon button. Objective: To present the results of the application of silicon ring expanding the voice prosthesis in patients with large and persistent peri-prosthetic fistula. Methods: A voice prosthesis was fitted to 42 patients after total laryngectomy. Leakage was detected around the prosthesis in 18 of these 42 patients. Four patients demonstrated improvement with conservative methods. Eight of 18 patients who couldn't be cured with conservative methods were treated by using primary suture closure and 4 patients were treated with local flaps. As silicon ring was applied as a primary treatment in the 2 remaining patients and also, applied to 2 patients who had recurrence after suture repair and to 2 patients who had recurrence after local flap implementation. Silicon rings were used in a total of 6 patients due to the secondary trachea-esophageal fistula. Patients were treated with provox-1 initially and later with provox-2. At the time of leakage around the fistula, 6 patients had provox-2. Results: Fistulae were treated successfully in 6 patients, and effective speech of patients was preserved. Patients experienced no adaptation problem. Prosthesis changing time was not different between silicon rings expanded and normal prosthesis applied patients. Silicon ring combined voice prosthesis was used 26 times; there was no recurrence in fistula complication during 29 ± 6 months follow up. Conclusion: Silicon rings for modified expanded voice prosthesis seems to be an effective treatment for persistent peri-prosthetic leakage, for both, fistula closure and preserving the patients speech.

Resumo Introdução: Fístulas traqueoesofágicas persistentes podem ser resolvidas através da redução do tamanho da fístula ou substituição da prótese; no entanto, mesmo com técnicas conservadoras, o pertuito em torno da fístula pode continuar em pacientes com laringectomia total. Além disso, várias técnicas têm sido desenvolvidas para superar esse problema, inclusive injeções ao redor da fístula, fechamento da fístula com retalhos locais, retalhos miofasciais ou retalhos livres e fechamento da fístula com um botão septal de silicone. Objetivo: Apresentar os resultados da aplicação de anel de silicone para expansão da prótese vocal em pacientes com grandes fístulas periprotéticas persistentes. Método: Prótese vocal foi colocada em 42 pacientes após laringectomia total, e fístula foi detectada ao redor da prótese em 18 desses 42 pacientes. Quatro pacientes obtiveram melhora com métodos conservadores. Oito dos 18 pacientes que não obtiveram sucesso com métodos conservadores foram tratados usando sutura primária e quatro pacientes foram tratados com retalhos locais. Um anel de silicone foi aplicado inicialmente nos dois pacientes restantes e, também, aplicado a dois pacientes que tiveram recorrência após a técnica de sutura e a dois pacientes que tiveram recorrência após a utilização de retalho local. No total, seis pacientes receberam anéis de silicone em decorrência da fístula traqueoesofágica secundária. Os pacientes haviam sido tratados com provox-1 inicialmente e posteriormente com provox-2. No momento da detecção da fístula em torno do estoma, seis pacientes haviam recebido provox-2. Resultados: A fístula foi tratada com sucesso em seis pacientes. Além disso, após o tratamento a fala foi mantida de forma eficaz. Não houve problema de adaptação. O tempo de troca da prótese expandida com os anéis de silicone não foi diferente do tempo que se leva para a colocação da prótese normal. O anel de silicone combinado com a prótese vocal foi usado 26 vezes em pacientes na época da troca de prótese e não houve recorrência da fístula durante os 29 ± 6 meses de acompanhamento. Conclusão: Os resultados sugerem que em casos de grandes fístulas peri-prostéticas persistentes, anéis expandidos de silicone e prótese vocal modificada são eficazes tanto para o fechamento da fístula como para a manutenção da fala do paciente.

End-to-end versus end-to-side anastomosis in the treatment of esophageal atresia or tracheo-esophageal fistula / Anastomose terminoterminal versus terminolateral no tratamento da atresia ou fístula traqueoesofágica

Background: Dehiscence of esophageal anastomosis is frequent and there are still controversies which type of anastomosis is preferred to diminish its incidence . Aim: To compare end-to-end anastomosis versus end-to-side anastomosis in terms of anastomotic leakage, esophageal stricture and gastroesophageal reflux symptom. Methods: This study was carried out for two year starting from 2012. End-to-side and end-to-side anastomosis were compared in terms of anastomotic leakage, esophageal stricture, gastroesophageal reflux symptom, length of surgery and pack cell infusion. Results: Respectively to end-to-end and end-to-side anastomosis, duration of surgery was 127.63±13.393 minutes and 130.29±10.727 minutes (p=0.353); esophageal stricture was noted in two (5.9%) and eight (21.1%) cases (p=0.09); gastroesophageal reflux disease was detected in six (15.8%) and three (8.8%) cases (p=0.485); anastomotic leakage was found in five (13.2%) and one (2.9%) cases (p=0.203); duration of neonatal intensive care unit admission was significantly shorter in end-to-end (11.05±2.438 day) compared to end-to-side anastomosis (13.88±2.306 day) (p<0.0001). Conclusion: There were no significant differences between end-to-end and end-to-side anastomosis except for length of neonatal intensive care unit admission which was significantly shorter in end-to-end anastomosis group.

Racional: Deiscência de anastomose esofágica é frequente e ainda existem controvérsias qual tipo de anastomose é preferível para diminuir sua incidência. Objetivo : Comparar a anastomose terminoterminal versus a lateroterminal em termos de deiscência de anastomose, estenose de esôfago, e sintoma de refluxo gastroesofágico. Métodos : Este estudo foi realizado por dois anos a partir de 2012. Anastomoses terminoterminal e terminolateral foram comparadas em termos de deiscência de anastomose, estenose de esôfago, sintoma do refluxo gastroesofágico, duração da operação e transfusão. Resultados : Na comparação das anastomoses terminoterminal e terminolateral, respectivamente, a duração em minutos das operações foi de 127.63±13.393 e 130.29±10.727 (p=0,353); estenose esofágica foi observada em dois (5,9%) e oito (21,1%) casos (p=0,09); doença do refluxo gastroesofágico foi detectada em seis (15,8%) e três (8,8%) casos (p=0,485); deiscência de anastomose foi encontrada em cinco (13,2%) e um (2,9%) caso (p=0,203); duração do internamento na UTI neonatal foi significativamente menor na terminoterminal (11,05±2,438 dias) em comparação com terminolateral (13,88±2,306 dias, p<0,0001). Conclusão : Não houve diferença significativa entre as anastomoses terminoterminal e terminolateral, exceto para UTI neonatal que foi significativamente menor no grupo de anastomose terminoterminal.

Anesthetic management for surgery of esophagus atresia in a newborn with Goldenhar's syndrome / Manejo anestésico para cirurgia de atresia de esôfago em um recém-nascido com síndrome de Goldenhar / Manejo anestésico para la cirugía de atresia de esófago en un neonato con síndrome de Goldenhar

Goldenhar's syndrome is a polymalformative condition consisting of a craniofacial dysostosis that determines difficult airway in up to 40% of cases. We described a case of a newborn with Goldenhar's syndrome with esophageal atresia and tracheoesophageal fistula who underwent repair surgery.

A síndrome de Goldenhar é um quadro de polimalformação que consiste em uma disostose craniofacial que determina uma via respiratória difícil em até 40% dos casos. Nós descrevemos um caso de um recém-nascido com síndrome de Goldenhar com atresia de esôfago e fístula traqueoesofágica para a qual foi feita cirurgia de reparo.

El síndrome de Goldenhar es un cuadro polimalformativo consistente en una disostosis craneofacial que condiciona una vía aérea difícil hasta en el 40% de los casos. Describimos un caso de un neonato con síndrome de Goldenhar con atresia de esófago y fístula traqueoesofágica al que se practicó cirugía de reparación de la misma.

Estoma traqueal persistente en pacientes tratados con tubo en T por estenosis traqueal isquémica / Persistenttrachealstoma in patients treated with T tubes duetoischemic trachealstenosis

Introducción: el estoma traqueal persistente o fístula traqueocutánea es una complicación tardía rara, que se caracteriza por la persistencia del orificio traqueal de 3 a 6 meses después de retirada la cánula de traqueostomía. Objetivo: describir las características y los resultados obtenidos en pacientes que presentaron fístula traqueocutánea después de retirar el tubo en T insertado para tratar estenosis isquémica de tráquea y subglotis. Métodos: una serie de 20 pacientes con fístula traqueocutánea fueron tratados en el servicio de Cirugía general del Hospital Hermanos Ameijeiras entre junio de 1993 y enero de 2011. Se describen las características de los pacientes en cuanto a edad, sexo, indicación quirúrgica, tiempo para retirar el tubo en T y detalles de la técnica quirúrgica. Resultados: el tiempo para retirar el tubo en T fluctuó entre 3 y 163 meses. Nueve enfermos permanecieron con el tubo hasta 12 meses, en 2 se retiró entre 13 y 36 meses y 9 fueron decanulados en 37 meses o más. Los pacientes tratados con colgajos de piel fueron 18 y con sutura simple, 2. Dos pacientes tuvieron infección de la herida, ambos en el grupo tratado con colgajo de piel, uno de los cuales tuvo recidiva de la fístula, que resolvió con una reintervención. Hubo seguimiento entre 6 y 61 meses, incluyendo el paciente reoperado. No se presentaron más recurrencias de la fístula ni de la estenosis. Conclusiones: el tratamiento quirúrgico con colgajo cutáneo es efectivo para tratar fístula traqueocutánea desarrolladas al retirar el tubo en T(AU)

Introduction: Persistent tracheal stoma or tracheocutaneous fistula is a late tare complication that is characterized by permanence of a tracheal orifice for 3 to 6 months after removing the tracheostomy cannula. Objective: To describe the characteristics and the results achieved in patients who presented with tracheocutaneous fistula after removing the inserted T-tube to treat ischemic stenosis of the trachea and subglottis. Methods: A series of 20 patients with tracheocutaneous fistula were treated at the general surgery service of Hermanos Ameijeiras hospital from June 1993 through January 2011. The characteristics of the patients in terms of age, sex, surgical indication, length of time for the removal of the T-tube and details of the surgical technique were described. Results: The length of time elapsed until the T-tube removal ranged from 3 to 163 months. Nine patients remained with the inserted T-tube for 12 months. The cannula was removed in 2 patients after 13 to 36 months and 9 were taken the cannula out after 37 months or more. The number of patients treated with cutaneous flaps amounted to 18 with single suture. Two patients suffered wound infection, both from the group under cutaneous flap treatment; one of them had fistula recurrence which was finally managed after reoperation. The follow-up lasted 6 to 61 months including the reoperated patient. Neither fistula nor stenosis recurrences were observed anymore. Conclusions: The surgical treatment with cutaneous flap is effective to treat tracheocutaneous fistula that may appear when the T-tube is removed(AU)

Uso do retalho microcirúrgico anterolateral da coxa na correção de fístula esôfago-cutânea / Use of the microsurgical anterolateral thigh flap to correct esophagocutaneous fistula

INTRODUÇÃO: O retalho anterolateral da coxa (RALC) vem se tornando uma ferramenta importante na reconstrução microcirúrgica de defeitos cutâneos e subcutâneos. Tendo em vista que o RALC pode se estender por até 35 cm, ele pode ser utilizado tanto na reconstrução esofágica como em defeitos cutâneos cervicais. RELATO DO CASO: Paciente C.S.M., sexo feminino, 57 anos, apresentando um carcinoma espinocelular de laringe foi submetida à radioterapia e tratamento cirúrgico de laringectomia total seguido de reconstrução por fechamento primário. Porém, a paciente evoluiu com uma complicação pósoperatória devido à formação de uma fístula esôfago-cutânea cervical, sendo necessária a realização de 4 procedimentos cirúrgicos para fechamento definitivo da fístula. O último procedimento consistiu na realização de retalho microcirúrgico da região anterolateral da coxa para correção da fístula esôfago-cutânea, objeto desse relato. CONCLUSÕES: O retalho microcirúrgico anterolateral da coxa possui extensa aplicação em diversos campos, baseada nas seguintes características: vascularização confiável, pedículo vascular longo e largo de no mínimo 8 cm, região do retalho extensa e de fácil delimitação, possibilidade de diminuir a espessura primária do retalho em 3 a 5 mm sem risco de comprometer sua vascularização, possibilidade de abordagem dupla simultânea devido à distância entre sítio doador e receptor, possibilidade de fechamento primário sem a necessidade de enxerto de pele. O relato do caso apresentado neste estudo justifica-se com o intuito de ressaltar a possibilidade da utilização microcirúrgica do RALC em sanduíche na correção de fístula esôfago-cutânea de alto débito.

INTRODUCTION: The anterolateral thigh (ALT) flap has become an important tool in the microsurgical reconstruction of cutaneous and subcutaneous defects. Since the ALT flap can be up to 35 cm long, it can be used in both, esophageal reconstruction and cervical skin defects. CASE REPORT: Patient C. S. M., a 57-year-old woman, presented with squamous cell carcinoma of the larynx and underwent radiotherapy and a total laryngectomy followed by reconstruction by primary closure. However, she developed a postoperative complication due to the formation of a cervical esophagocutaneous fistula that required four surgical procedures to ensure permanent closure. The latter procedure consisted of the creation of a microsurgical ALT flap to correct the esophagocutaneous fistula, the subject of this report. CONCLUSIONS: The microsurgical ALT flap has extensive applications in various fields based on the following characteristics: reliable vascularization, long and broad vascular pedicle (at least 8 cm long), an extensive and easily delimited flap region, the possibility of reducing the primary flap thickness to 3-5 mm without compromising its vascularization, the possibility of a simultaneously dual approach because of the distance between the donor and recipient site, and the possibility of primary closure without the need for skin grafting. The case report presented in this study emphasizes the possibility of the use of a microsurgical ALT sandwich flap to correct a high output esophagocutaneous fistula.

Reparación toracoscópica de atresia esofágica con y sin fistula traqueoesofágica / Thoracoscopic repair of esophageal atresia with and without tracheoesophageal fistula

Introduction: Esophageal atresia (EA) is the interruption of the continuity of the esophagus, with or without persistent communication with the trachea. Recent advances in surgical techniques have made possible correction with minimally invasive surgery (MIS). Objective: To evaluate the management of thoracoscopic technique in the treatment of EA. Patients and Method: Retrospective analysis of medical records in two centers was carried out between 2007 and 2012. Variables such as gestational age, gender, weight, type of esophageal atresia, malformations, surgery and postoperative complications were recorded. Results: Twenty patients, 15 of them with type III EA, 4 with type I and one unclassifiable, were part of the study. 13 patients underwent ligation, cut of tracheoesophageal fistula and end to end anastomosis. Two underwent laparoscopic gastrostomy and fistula ligation. One patient required conversion and underwent esophagostomy plus gastrostomy. 4 patients without fistula required laparoscopic gastrostomy and aspiration of the proximal esophagus to be able to perform esophageal anastomosis. In the postoperative period, pleural drainage and a transanastomotic feeding tube were installed. Seven patients required esophageal dilations and 4 patients developed stenosis due to reflux. Two had recurrent fistula, one with spontaneous resolution and another with endoscopic resolution. Three children died: two of them due to pathologies not related to surgery and one as a result of limitation of therapeutic effort after fistula patency. Discussion: Esophageal atresia repair with MIS is a safe and effective option with excellent exposure and visualization of anatomic landmarks and little associated morbidity.

Introducción: Atresia esofágica (AE) es la interrupción de la continuidad del esófago, con o sin comunicación con la tráquea. Los avances en cirugía han permitido su corrección con cirugía mínimamente invasiva (CMI). Objetivo: Evaluar el manejo toracoscópico en AE. Pacientes y Método: Revisión retrospectiva de fichas de 2 centros entre 2007 y 2012. Se registraron variables como edad gestacional, sexo, peso, tipo de atresia esofágica, malformaciones, cirugías y complicaciones postquirúrgicas. Resultados: Veinte pacientes, 15 tipo III, 4 tipo I y uno no clasificable. En 13 pacientes se realizó ligadura, sección de fístula tráqueo-esofágica y anastomosis término-terminal. Dos fueron sometidos a gastrostomía laparoscópica más ligadura de fístula. Un paciente requirió conversión y se realizó esofagostomía más gastrostomía. En 4 pacientes sin fístula, se realizó gastrostomía laparoscópica y aspiración del esófago proximal hasta lograr realizar la anastomosis esofágica. En el post-operatorio se instaló drenaje pleural y sonda trans-anastomótica. Siete pacientes requirieron dilataciones esofágicas y 4 desarrollaron estenosis por reflujo. Dos presentaron fístula recidivada, uno con resolución espontánea y el segundo de resolución endoscópica. Tres niños fallecieron: dos por patologías no relacionadas con la cirugía y uno con limitación de esfuerzo terapéutico con repermeabilización de fístula. Discusión: La atresia esofágica reparada con CMI es una opción segura y efectiva en esta serie, permitiendo excelente exposición y visualización de reparos anatómicos, con poca morbilidad asociada.

Management of esophageal atresia and tracheoesophageal fistula - review of 05 years

To analyze the morbidity and mortality in 38 patients with variants of esophageal atresia and trachea-esophageal fistula who were treated between January 2007 and January 2012. This is a retrospective study. Data were collected from hospital records. The study was conducted at the Children Hospital Quetta from January 2007 to January 2012. The records of 38 patients of esophageal atresia and trachea-esophageal fistula were reviewed. The mean birth weight was 2.5 kg and mean gestational age was 38 weeks [range 30 to 38 weeks]. The risk classification was based on Waterston's classification and included 18 case of type[A] 12 cases of type [B] and 8 cases of type [C.] There were associated anomalies in many patients that included, cardiac, skeletal neurological and renal and anorectal defects. There was an anastomotic leak in 8 patients [21.05%], sepsis in 12 [13.5%], pneumothorax was recorded in 3 patients [7.8%].The results of this congenital malformation requiring surgical treatment, is less than optimal in our setup. The likely reasons are late presentation, and less than ideal neonatal services

Atresia esofágica y fístula traqueoesofágica: evolución y complicaciones postquirúrgicas / Esophageal atresia and tracheoesophagic fistula: evolution and postsurgical complications

Esophageal atresia (EA) and tracheoesophageal fistula are congenital anomalies associated with respiratory and gastrointestinal morbidity. Objective: The aim of this study was to describe clinical characteristics of patients with EA and TEF during childhood, specially focused on respiratory and gastrointestinal complications. Methods: We reviewed the clinical charts from fifteen patients admitted to our hospital and who were followed locally between 1995 and 2007. Results: Gross classification distribution was: A: 0, B: 0, C: 12, D: 2, E: 1. Waterston distribution was Al: 6, B1: 1, B2: 4y C2: 4. Associated malformations to EA and TEF were 7/15. Main morbidity during the follow up period was: Recurrent pneumonia: 6/15, recurrent wheezing 12/15, tracheomalacia in 9/15 and apnea in one patient. Fistula re-opening in 3/15, Gastro esophageal reflux in 15/15 esophagic stenosis in 7/15. All patients were admitted to the hospital at least once during the follow up and in 12/15 of this were due to respiratory causes. Conclusions: EA and TEF after surgical repair have significant respiratory and gastrointestinal morbidity and frequent admission to the hospital during the first years of life.

La Atresia esofágica (AE) con o sin fístula traqueoesofágica (FTE) es una malformación congénita que se asocia a complicaciones respiratorias y digestivas. Objetivo: Describir las características de estos pacientes, su morbilidad respiratoria, digestiva y hospitalizaciones en su evolución a largo plazo. Materiales y Métodos: Se revisaron en forma retrospectiva 15 fichas de pacientes con diagnóstico de FTE evaluados por el equipo de Neumología Pediátrica de la Universidad Católica de Chile entre 1995 y 2007. Resultados: N = 15 pacientes, sexo masculino 9 diagnóstico el primer día de vida 13/15 pacientes. Clasificación de Gross: A= 0, B= 0, C= 12, D= 2, E= 1. Clasificación de Waterston Al: 6, Bl: 1, B2: 4 y C2: 4 Malformaciones asociadas: en 7/15. Complicaciones respiratorias: Neumonía recurrente 8/15, sibilancias recurrentes 12/15, Recurrencia de fístula: 3 /15 pacientes, Apnea: 1 paciente, Traqueomalacia (TM) (9/15). Complicaciones digestivas: Reflujo gastroesofágico 15/15, Estenosis esofágica: II15. Un paciente requirió cirugía de Nissen. Todos los pacientes se hospitalizaron en al menos una oportunidad y en el 12/15 la causa fue respiratoria. Conclusión: La FTE es una enfermedad de resolución quirúrgica con alta morbilidad respiratoria, digestiva y frecuentes hospitalizaciones en los primeros años de vida.

[Isolated congenital tracheoesophageal fistula. About two cases revealed in neonate]

The authors report two cases of isolated tracheoesophageal fistula revealed in neonate. It is a rare malformation that presents with a characteristic triad of symptoms: choking and cyanosis on feeding, abdominaldistension and recurrent respiratory tract infection. Children are invariably symptomatic from birth. These symptoms may be intermittent and may vary in severity. The barium swallow confirms the diagnosis and determins its location in two cases. The treatment is surgical

Traumatic tracheoesophageal fistula [TTEF]: case report

Acquired tracheoesophageal fistulas [TEFs] occur secondary to malignant disease [esophageal or bronchial], infection or trauma. Postintubation TEFs uncommonly occurs following prolonged ventilation with an endotracheal or tracheostomy tube. We report a 23 year old woman who, following of 2 weeks mechanical ventilation, presented with recurrent aspiration pneumonia and dyspnea directly post extubation. Bronchoscopy showed mild tracheal stenosis and 3 cm long traheoesophageal fistula. A4 cm tracheal resection and reconstruction with closing the esophageal fistula was performed successfully

Fístula esôfago-traqueal após ingestão cáustica / Tracheoesophageal fistula after caustic ingestion

As fístulas esôfago-traqueais são incomuns e apresentam diversas etiologias, entre elas, a queimadura química esofágica devida à ingestão cáustica. Relatamos o caso de um paciente de 27 anos com história de ingestão cáustica havia catorze dias, com dor retroesternal em queimação, fraqueza, tosse com escarro purulento e dispnéia associada à rouquidão no último dia. A endoscopia digestiva alta e a broncofibroscopia revelaram fístula esôfago-traqueal. O tratamento consistiu no suporte clínico, drenagem torácica bilateral, exclusão do transito esofágico com esofagostomia cervical terminal e gastrostomia. Houve cicatrização espontânea da fístula esôfago traqueal em seis semanas. Posteriormente, realizou-se a reconstrução do trânsito alimentar através de faringocoloplastia. A evolução pós-operatória foi satisfatória.

Tracheoesophageal fistulas are uncommon and present diverse etiologies, among which is burning of the esophagus due to caustic ingestion. Herein, we report the case of a 27-year-old male patient having ingested a caustic substance 14 days prior and presenting burning retrosternal pain, weakness, productive cough with purulent sputum and dyspnea accompanied by hoarseness for the preceding 24 h. Endoscopy of the upper digestive tract revealed a tracheoesophageal fistula. Treatment consisted of cervical exclusion of the esophageal transit, together with gastrostomy. Subsequently, the nutrient transit was reconstructed through pharyngocoloplasty. The postoperative evolution was favorable.

[Fiberoptic laryngoscopic assisted diagnosis and operation of congenital and recurrent tracheoesophageal fistula]

Fiberoptic laryngoscopy [FOL] is usually used in the management of difficult airway intubations. Since its introduction, it has been used for few other indications. In this paper we present a new indication of fiberoptic bronchoscopy [FB] to detect the exact location of tracheoesphageal fistula [TEF] intraoperatively in fourteen cases of pediatric group patients to prevent an unnecessary traumatic manipulation during operation. In all of these cases [12 esophageal atresia and TEF and 1 recurrent TEF and 1 pure TEF] we were able to detect the exact location of TEF with using a LF type Fiberoptic laryngoscope which was been passed through the endotracheal tube. The TEF could then be found and repaired perfectly with minimal dissection and trauma to the trachea and esophagus through thoracotomy [Except 1 case that did not need thoracotomy] Postoperative course was uneventful and all of the patients were discharged in good condition. We believe that intraoperative fiberoptic bronchoscopy in these types of operations not only leads to shortening the operation time, but it can also prevent unnecessary trauma to vital thoracic organs

Peri-operative anaesthetic management of neonates for surgical emergencies.

Surgery of neonates can be fraught with hazards unless the anaesthesiologist is conversant with the physiologic and pharmacologic responses under anaesthesia and surgery. The principles of anaesthetic management for surgery of critically ill neonates with common congenital malformations are briefly discussed in this article.

Fístula traqueoesofágica en H: reporte de un caso y revisión de la literatura / H-Type tracheoesophageal fistula: report of case and review of th literature

Se informa el primer paciente operado en el Hospital de Especialidades del Instituto Hondureño de Seguridad Social con una fístula traqueoesofágica en H. La cirugía consistió en una toracotomía posterolateral derecha con resección de la fístula y reparación del esófago y la traquea. La fístula traqueoesofágica en H es una anormalidad congénita rara que constituye únicamente el 4% de todos los tipos de malformaciones congénitas de esófago. El diagnóstico puede realizarse al nacimiento pero en ocaciones este pasa desapercibido y se manifiesta como una neumopatía crónica como en el presente caso, constituyendo el diagnóstico un verdadero reto para los médicos tratantes...

Esophageal atresia with or without tracheoesophageal fistula: success and failure in 94 cases

The management of newborns with esophageal atresia [EA] with or without tracheoesophageal fistula [TEF] has evolved considerably over the years. Currently an overall survival of 85% to 90% has been reported from developed countries. In developing Countries, several factors contribute to higher mortality rates. We describe our experience with 94 consecutive cases of EA with or without TEF. We retrospectively studied 94 patients with EA with or without TEF treated at our hospital over a period of 15 years. Medical records were reviewed for age at diagnosis, sex, birth weight, associated anomalies, aspiration pneumonia, method of diagnosis, treatment, postoperative complications and outcome. Ninety-four newborns [55 males and 39 females] with EA/TEF were treated at our hospital. Their mean birth weight was 22 kg [700 g to 3800 g]. Age at diagnosis ranged from birth to 7 day. At the time of admission 37 [39.4%] had aspiration pneumonia. Associated anomalies were seen in 46[49%] patients. Thirteen patients had major associated anomalies that contributed to mortality Postoperative complications were similar to those from developed countries but overall operative mortality [30.8%] was high. The overall mortality was high but excluding major congenital malformations, sepsis was the most frequent cause of death. Factors contributing to mortality included prematurity, delay in diagnosis with an increased incidence of aspiration pneumonia and a shortage of qualified nurses. To improve overall outcome, factors contributing to sepsis should be evaluated and efforts should be made to overcome them