TITLE:
Endoscopic Detection and Surgical Repair of Congenital Tracheo-Esophageal-Fistula (TEF) ± Esophageal Atresia (EA)
AUTHORS:
Ralf-Bodo Tröbs, Werner Finke
KEYWORDS:
Tracheoesophageal Fistula, Esophageal Atresia, Tracheo-Bronchoscopy, Airway Management, Cervical Approach
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.4 No.4,
November
26,
2014
ABSTRACT: Purpose: This study was performed to
evaluate the management of tracheoesophageal fistula (TEF) ± esophageal atresia (EA) under the
guidance of preoperative tracheo-bronchoscopy (TrSc). Methods: Between 2007 and
July 2014, a total of 26 consecutive newborns who underwent rigid TrSc for
suspected TEF were identified. All associated charts and operation reports were
retrospectively analyzed. Results: Distal
TEF with EA (Gross C) predominated (n = 18). Furthermore, we managed 2 infants
with proximal and distal TEF (Gross D) and 4 infants with isolated TEF (Gross
E). In our hands, TrSc was feasible in infants with a birth weight above 1300
g. Twenty-five fistulas were identified by endoscopy in 23 patients. In one
infant with a birth weight below 1000 g, an attempt to perform TrSc was
interrupted, and urgent TEF closure was required. Fistula site at the carina
was associated with a high rate of esophageal anastomosis under tension. During
surgery, proximal TEF and isolated TEF were safely approached via right
cervicotomy (n =5). Conclusion:
This study supports the routine use of rigid TrSc at the time of surgery. Rigid
TrSc allowed the surgical team to identify the number and location of TEFs, and
the incidence of side effects was low.