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Gastrointestinal Endoscopy Jun 2004
Topics: Bronchoscopy; Esophagoscopy; Female; Humans; Intubation, Intratracheal; Middle Aged; Respiration, Artificial; Tracheoesophageal Fistula
PubMed: 15173805
DOI: 10.1016/s0016-5107(04)00342-6 -
Pediatric Surgery International Oct 2023This study was performed to describe the current clinical practice and outcomes of type D esophageal atresia. We retrospectively analyzed 10 patients who were diagnosed... (Review)
Review
This study was performed to describe the current clinical practice and outcomes of type D esophageal atresia. We retrospectively analyzed 10 patients who were diagnosed with type D esophageal atresia and underwent esophageal atresia and tracheoesophageal fistula repair in the Capital Institute of Pediatrics and Beijing Children's Hospital from January 2017 to May 2022. Ten patients include three newborns and seven non-newborns. Seven (70%) cases were misdiagnosed as type C esophageal atresia before the first operation. Three neonatal children underwent thoracoscopic distal tracheoesophageal fistula ligation and esophageal anastomosis: the proximal tracheoesophageal fistula was simultaneously repaired with thoracoscopy in one of these children, and the proximal tracheoesophageal fistula was not detected under thoracoscopy in the other two children. Among the seven non-neonatal children, one underwent repair of the proximal tracheoesophageal fistula through the chest and the other six underwent repair through the neck. Nine patients were cured, and one died of complications of severe congenital heart disease. Type D esophageal atresia lacks specific clinical manifestations. Misdiagnosis as type C esophageal atresia is the main cause of an unplanned reoperation. Patients without severe malformations have a good prognosis.
Topics: Humans; Infant, Newborn; Child; Esophageal Atresia; Tracheoesophageal Fistula; Retrospective Studies; Thoracoscopy; Digestive System Surgical Procedures
PubMed: 37815659
DOI: 10.1007/s00383-023-05519-6 -
European Annals of Otorhinolaryngology,... Oct 2022Tracheoesophageal fistula (TEF) constitutes a rare, but serious complication in laryngectomized patients, usually occurring after radiotherapy. TEF may occur...
Tracheoesophageal fistula (TEF) constitutes a rare, but serious complication in laryngectomized patients, usually occurring after radiotherapy. TEF may occur spontaneously or may be due to enlargement of the TEF created for placement of a voice prosthesis. Surgical treatment of TEF can be complex, especially in the presence of a concomitant pharyngoesophageal stenosis (PES), and is associated with a high failure rate. In this article, we describe the surgical reconstruction technique for TEF associated with PES using a double skin paddle fasciocutaneous radial forearm free flap. The key points of this technique consist of correct positioning of the 2 skin paddles in order to reconstruct the anterior pharyngoesophageal wall and posterior tracheal wall, as well as de-epidermization of the intermediate part of the flap, which is then placed in the tracheoesophageal space.
Topics: Constriction, Pathologic; Humans; Laryngectomy; Larynx, Artificial; Surgical Flaps; Tracheoesophageal Fistula
PubMed: 34531167
DOI: 10.1016/j.anorl.2021.09.002 -
World Journal of Gastroenterology Jul 2012Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common congenital anomaly of the esophagus. The improvement of survival observed over... (Review)
Review
Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common congenital anomaly of the esophagus. The improvement of survival observed over the previous two decades is multifactorial and largely attributable to advances in neonatal intensive care, neonatal anesthesia, ventilatory and nutritional support, antibiotics, early surgical intervention, surgical materials and techniques. Indeed, mortality is currently limited to those cases with coexisting severe life-threatening anomalies. The diagnosis of EA is most commonly made during the first 24 h of life but may occur either antenatally or may be delayed. The primary surgical correction for EA and TEF is the best option in the absence of severe malformations. There is no ideal replacement for the esophagus and the optimal surgical treatment for patients with long-gap EA is still controversial. The primary complications during the postoperative period are leak and stenosis of the anastomosis, gastro-esophageal reflux, esophageal dysmotility, fistula recurrence, respiratory disorders and deformities of the thoracic wall. Data regarding long-term outcomes and follow-ups are limited for patients following EA/TEF repair. The determination of the risk factors for the complicated evolution following EA/TEF repair may positively impact long-term prognoses. Much remains to be studied regarding this condition. This manuscript provides a literature review of the current knowledge regarding EA.
Topics: Adult; Anastomosis, Surgical; Child; Child, Preschool; Esophageal Atresia; Esophageal Stenosis; Esophagus; Gastroenterology; Gastroesophageal Reflux; Humans; Infant; Infant, Newborn; Prognosis; Risk Factors; Surgical Procedures, Operative; Time Factors; Tracheoesophageal Fistula; Treatment Outcome
PubMed: 22851858
DOI: 10.3748/wjg.v18.i28.3662 -
American Journal of Medical Genetics.... Dec 2022Esophageal atresia/tracheoesophageal fistula (EA/TEF) is a life-threatening birth defect that often occurs with other major birth defects (EA/TEF+). Despite advances in...
Esophageal atresia/tracheoesophageal fistula (EA/TEF) is a life-threatening birth defect that often occurs with other major birth defects (EA/TEF+). Despite advances in genetic testing, a molecular diagnosis can only be made in a minority of EA/TEF+ cases. Here, we analyzed clinical exome sequencing data and data from the DECIPHER database to determine the efficacy of exome sequencing in cases of EA/TEF+ and to identify phenotypic expansions involving EA/TEF. Among 67 individuals with EA/TEF+ referred for clinical exome sequencing, a definitive or probable diagnosis was made in 11 cases for an efficacy rate of 16% (11/67). This efficacy rate is significantly lower than that reported for other major birth defects, suggesting that polygenic, multifactorial, epigenetic, and/or environmental factors may play a particularly important role in EA/TEF pathogenesis. Our cohort included individuals with pathogenic or likely pathogenic variants that affect TCF4 and its downstream target NRXN1, and FANCA, FANCB, and FANCC, which are associated with Fanconi anemia. These cases, previously published case reports, and comparisons to other EA/TEF genes made using a machine learning algorithm, provide evidence in support of a potential pathogenic role for these genes in the development of EA/TEF.
Topics: Humans; Tracheoesophageal Fistula; Esophageal Atresia; Exome; Exome Sequencing
PubMed: 36135330
DOI: 10.1002/ajmg.a.62976 -
Scientific Reports Mar 2023There are various surgical methods for tracheoesophageal fistula; however, there is presently no unified standard. Based on the magnetic compression technique, we...
There are various surgical methods for tracheoesophageal fistula; however, there is presently no unified standard. Based on the magnetic compression technique, we designed a novel method for the treatment of tracheoesophageal fistula. The purpose of this study was to verify its feasibility in an animal experiment. Six beagle dogs underwent surgical repair after constructing a tracheoesophageal fistula model. After the tracheal and esophageal spaces were freed during the operation, two magnets were used to clamp the fistula. The operation time, intraoperative blood loss, postoperative complications, and wound healing were monitored. Samples were obtained 14 days after the operation, and fistula repair was observed. The tracheoesophageal fistula repair operation was successfully completed for all six beagles. The average operation time was 23.67 ± 4.50 min. The average intraoperative blood loss was less than 10 mL. One dog had a postoperative wound infection, and the rest had no postoperative complications. The wound healed well. In all dogs, after specimen collection, it was observed that the fistula was successfully closed and the mucosal layer was smooth and flat. Histological observation showed that the anastomosis was slightly inflamed, the mucosal layer and surrounding tissues were arranged neatly, and the structure was slightly disordered. Magnetic compression technique can be effectively used to repair tracheoesophageal fistula, shorten the operation time, and simplify the operation procedure, and thus, it has the potential for clinical application.
Topics: Dogs; Animals; Tracheoesophageal Fistula; Trachea; Anastomosis, Surgical; Magnetic Phenomena
PubMed: 36964166
DOI: 10.1038/s41598-023-31903-2 -
Pediatric Surgery International May 2020Tracheoesophageal fistula (TEF) is a bellwether for a country's ability to care for sick newborns. We aim to review the existing literature from low- and... (Review)
Review
PURPOSE
Tracheoesophageal fistula (TEF) is a bellwether for a country's ability to care for sick newborns. We aim to review the existing literature from low- and middle-income countries in regard to management of those newborns and the possible approaches to improve their outcomes.
METHODS
A review of the existing English literature was conducted with the aim of assessing challenges faced by providers in LMIC in terms of diagnostic, preoperative, operative and post-operative care for TEF patients. We also review the limited literature for performing thoracoscopic repair in the developing world context and suggest methods for introduction of advanced thoracoscopic procedures including techniques for providing anesthesia to these challenging babies.
RESULTS
While outcomes related to technique from LMIC are comparable to the developed world, rates of secondary complications like sepsis and pneumonia are higher. In many areas, repairs are conducted in a staged fashion with minimal utilization of thoracoscopic approach. The paucity of resources creates strain on intraoperative and post-operative management.
CONCLUSION
Clearly, not all developing world contexts are ready to attempt thoracoscopic repair but we outline suggestions for assessing the existing capabilities and a stepwise gradual implementation of advanced thoracoscopy when appropriate.
Topics: Developing Countries; Humans; Morbidity; Postoperative Care; Thoracoscopy; Tracheoesophageal Fistula
PubMed: 32219560
DOI: 10.1007/s00383-020-04639-7 -
Early Human Development Nov 2022
Topics: Infant, Newborn; Humans; Tracheoesophageal Fistula; Esophageal Atresia
PubMed: 36242842
DOI: 10.1016/j.earlhumdev.2022.105681 -
Chirurgia (Bucharest, Romania : 1990) 2017Postintubation tracheoesophageal fistula is a severe complication occurring under certain conditions in patients that require prolonged mechanical ventilation.
UNLABELLED
Postintubation tracheoesophageal fistula is a severe complication occurring under certain conditions in patients that require prolonged mechanical ventilation.
MATERIAL AND METHODS
This article focuses on a sample of 11 patients with postintubation tracheoesophageal fistula, operated in our department between 2005 and 2015. The anterior approach with tracheal resection was performed in 10 of these patients, while an atypical surgical technique was preferred in a case involving a large-sized fistula. Three of these patients were subject to surgery while still on the ventilator, in order to help weaning them from mechanical ventilation. Two patients were operated following a relapse of the fistula, after attempts of closing it in other surgical units. Two patients (of those who were still on mechanical ventilation) died from intubation-related complications that persisted after tracheal resection (anastomotic dehiscence with mediastinitis and tracheoarterial fistula in the brachiocephalic arterial trunk). The nine remaining patients improved, with their airways restored and having regained normal deglutition. The surgical approach of this pathology is successful in surgical units that are specialised in tracheal and oesophageal surgery. Adequately timing the surgery is crucial for a good outcome.
Topics: Adult; Anastomosis, Surgical; Esophagoplasty; Esophagus; Female; Humans; Intubation, Intratracheal; Male; Middle Aged; Postoperative Complications; Prognosis; Plastic Surgery Procedures; Recurrence; Retrospective Studies; Survival Rate; Trachea; Tracheoesophageal Fistula; Treatment Outcome
PubMed: 29288612
DOI: 10.21614/chirurgia.112.6.696 -
Orphanet Journal of Rare Diseases May 2007Oesophageal atresia (OA) encompasses a group of congenital anomalies comprising of an interruption of the continuity of the oesophagus with or without a persistent... (Review)
Review
Oesophageal atresia (OA) encompasses a group of congenital anomalies comprising of an interruption of the continuity of the oesophagus with or without a persistent communication with the trachea. In 86% of cases there is a distal tracheooesophageal fistula, in 7% there is no fistulous connection, while in 4% there is a tracheooesophageal fistula without atresia. OA occurs in 1 in 2500 live births. Infants with OA are unable to swallow saliva and are noted to have excessive salivation requiring repeated suctioning. Associated anomalies occur in 50% of cases, the majority involving one or more of the VACTERL association (vertebral, anorectal, cardiac, tracheooesophageal, renal and limb defects). The aetiology is largely unknown and is likely to be multifactorial, however, various clues have been uncovered in animal experiments particularly defects in the expression of the gene Sonic hedgehog (Shh). The vast majority of cases are sporadic and the recurrence risk for siblings is 1%. The diagnosis may be suspected prenatally by a small or absent stomach bubble on antenatal ultrasound scan at around 18 weeks gestation. The likelihood of an atresia is increased by the presence of polyhydramnios. A nasogastric tube should be passed at birth in all infants born to a mother with polyhydramnios as well as to infants who are excessively mucusy soon after delivery to establish or refute the diagnosis. In OA the tube will not progress beyond 10 cm from the mouth (confirmation is by plain X-ray of the chest and abdomen). Definitive management comprises disconnection of the tracheooesophageal fistula, closure of the tracheal defect and primary anastomosis of the oesophagus. Where there is a "long gap" between the ends of the oesophagus, delayed primary repair should be attempted. Only very rarely will an oesophageal replacement be required. Survival is directly related to birth weight and to the presence of a major cardiac defect. Infants weighing over 1500 g and having no major cardiac problem should have a near 100% survival, while the presence of one of the risk factors reduces survival to 80% and further to 30-50% in the presence of both risk factors.
Topics: Abnormalities, Multiple; Animals; Digestive System Surgical Procedures; Esophageal Atresia; Genetic Testing; Humans; Infant, Newborn; Patient Selection; Preoperative Care; Prognosis; Risk Assessment; Tracheoesophageal Fistula
PubMed: 17498283
DOI: 10.1186/1750-1172-2-24