H-Type Tracheoesophageal Fistula Cannulation for Rapid Intraoperative Localization.

Various techniques for tracheoesophageal fistula cannulation have been reported. In this case, we created a loop using a plastic catheter. The loop allowed us to create traction for rapid intraoperative localization and to pull a difficult-to-reach fistula, superiorly into the neck, to be reached through a cervical approach. Laryngoscope, 133:2425-2427, 2023.

Surgical approach for iatrogenic tracheoesophageal fistula. Case report and literature review.

BACKGROUND: Post-intubation tracheoesophageal fistula is a severe complication in long-term mechanical ventilation patients with possible fatal consequences. OBJECTIVE: To describe a case of post-intubation tracheoesophageal fistula and its surgical management. In addition, a brief literature review was effectuated. CASE REPORT: 45-year-old female, suffers ischemic stroke with progressive neurological damage that requires long-term mechanical ventilation. During endoscopic gastrostomy tracheoesophageal fistula is shown. RESULTS: Undergoes surgery for esophageal repair and tracheal resection, through cervicosternotomy. Unfortunately died in the immediate postoperative period. CONCLUSIONS: This complex pathology requires structured protocols for its prevention in patients in whom long-term mechanical ventilation is expected.

ANTECEDENTES: La fístula traqueoesofágica es una complicación en pacientes con ventilación mecánica prolongada. La contaminación pulmonar permanente puede ser grave, con evolución fatal. OBJETIVO: Describir un caso de fístula traqueoesofágica posintubación y hacer una breve revisión de la literatura. CASO CLÍNICO: Mujer de 45 años que sufre un evento cerebrovascular isquémico que condiciona deterioro neurológico progresivo, ameritando ventilación mecánica prolongada. Durante la gastrostomía endoscópica se evidencia una fístula. RESULTADOS: Intervenida quirúrgicamente para reparación esofágica y resección traqueal mediante cervicoesternotomía, lamentablemente fallece en el posoperatorio inmediato. CONCLUSIONES: Esta patología es compleja. Deben implementarse protocolos enfocados en su prevención en pacientes en quienes se espera una ventilación mecánica prolongada.

Early presentation of post-intubation tracheoesophageal fistula with severe tracheal stenosis in COVID-19 patient.

The current global COVID-19 pandemic is caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Currently, acquired tracheoesophageal fistulas are mainly iatrogenic lesions produced by prolonged tracheal intubation. We present a case of tracheoesophageal fistula with severe tracheal stenosis following tracheal intubation in a patient with SARS-CoV-2 infection.

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.

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

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.

Endoscopic closure of tracheoesophageal fistula for tuberculosis with an over-the-scope-clip.

Surgical management has been the main approach for enteral fistulae. This approach is usually complex due to comorbidities, a wasted nutritional state and anatomical difficulties related to prior multiple interventions. Therefore, endoscopic methods such as clips, self-expanding metal stent (SEMS) and recently, the over scope clip (OTSC®) are increasing in popularity and use. Herein, we present the case of a patient with a HIV infection who was admitted due to respiratory symptoms. Radiological and microbiological studies documented a tracheoesophageal fistula due to tuberculosis (TB) and cytomegalovirus (CMV) infection. Therefore, an esophageal fully-covered stent was placed, which migrated into the stomach. The thoracic surgeons considered an esophagectomy with gastric ascent and muscle patch in the trachea. However, due to his poor nutritional status and comorbidity, an OTSC was placed to treat the fistulae. The patient also received medical treatment with anti-tuberculotics and anti-retrovirals.

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.

Treatment of large persistent tracheoesophageal peristomal fistulas using silicon rings.

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.

Validation of an inanimate low cost model for training minimal invasive surgery (MIS) of esophageal atresia with tracheoesophageal fistula (AE/TEF) repair.

UNLABELLED: We present the results of the validation of an inanimate model created for training thoracoscopic treatment of esophageal atresia with lower tracheoesophageal fistula (EA/TEF). MATERIALS AND METHODS: We used different domestic materials such as a piece of wood (support), corrugated plastic tubes (PVC) of different sizes to simulate ribs, intercostal spaces, trachea and spine and tubular latex balloons to simulate the esophagus and lungs to make the basic model. This device was inserted into the thoracic cavity of a rubber dummy simulating a 3kg newborn with a work area volume of 50ml. The model was designed taking into account the experience of doing this procedure in neonates. The cost of the materials used was 50 US$. Regular video endoscopic equipment and 3mm instruments were used. Thirty-nine international faculty or pediatric surgeons attending hands on courses with different levels of training in minimal invasive surgery (MIS) repair of EA/TEF performed the procedure in the model. We compared the performance of the practitioners with their experience in thoracoscopic repair of EA. A Likert-type scale was used to evaluate results. Previous experience in MIS, anatomical appearance of the model, surgical anatomy compared to a real patient, and utility as a training method were analyzed. We also used a checklist to assess performance. We evaluated: number of errors and types of injuries, quality of the anastomosis, and duration of procedure. To analyze the results we used a T-test, chi-square test and Excel® database to match up some results. RESULTS: Thirty-nine questionnaires were completed. Seven surgeons were experts (≥30 TEF/EA repairs as surgeon), 10 had intermediate level of experience (5 to 29 repairs as surgeon) and 22 were beginners (less than 5 repairs). To simplify the analysis we divided the respondents into low experience LE (<5 real procedures-beginners; n=22) and high experience HE (intermediate, 10; and experts, 7; n=17). In relation to the anatomical characteristics of the model, 94.48% (n=37) respondents considered that the model has a high degree of similarity or good similarity; in relation to surgical anatomy 88.2% (n=34) respondents considered that the model has a high degree of similarity or good similarity; 87.17% (n=34) respondents considered that the model can generate a good amount of skills and/or can generate great majority of skills to EA/TEF repair; and 12.82% (n=5) respondents consider that it can generate some skills or a few skills, only in relation to trocar placement, one of the surveyed items. The number of errors was 29±7 SD (20 to 51) for the low experience group (LE) and 9±6 SD (1 to 20) for the high experience group (HE) (P value<0.0001). Time in minutes was significantly lower in the HE group (40±9 SD; 26 to 58min), in relation with LE (81±19 SD; 49 to 118min) (P<0.0001, T-test). Deficient or incomplete anastomosis also showed differences: 7 (32%) in the LE group and 1 (6%) in the HE group (P = 0.04, chi-square test). We saw a correlation between the previous experience of the surgeon and their performance in the model considering operating time, quality of anastomosis and peripheral tissue damage. According to the suggestions registered in the questionnaires, we have now improved the model. We have also started using it in a scenario to simulate the whole neonatal MIS operative room setting and team work.

Surgical Management of Benign Acquired Tracheoesophageal Fistulas: A Ten-Year Experience.

BACKGROUND: Benign tracheoesophageal fistulas (TEFs) are rare, and surgical correction is the ideal method of treatment. The objective of this study was to evaluate the results of operative treatment of benign TEFs in patients from a tertiary referral center. METHODS: Retrospective study of patients with benign TEFs who were treated between January 2005 and December 2014. Preoperative evaluation included computed tomography of the chest, bronchoscopy, and upper endoscopy. Preoperative treatment included nutritional support by gastrostomy and treatment of lung infections. Surgical repair was done with tracheal resection and reconstruction, laryngotracheal resection, or membranous tracheal repair without resection. Esophageal management consisted of two-layer closure. RESULTS: Twenty patients (11 men) with mean age 48 ± 17 years were included. The most frequent cause was postintubation injury (n = 16; 80%). The median TEF length was 9 mm (interquartile range [IQR], 2 to 25 mm). The most commonly used surgical approaches were cervicotomy (n = 15; 75%) and cervicosternotomy (n = 3; 15%). Eleven patients required tracheal resection; median length was 3 cm (IQR, 3 to 5.5 cm). Seven patients (35%) required intraoperative tracheostomy. Complications occurred in 55% of patients. There was one dehiscence of the tracheal anastomosis, and one procedure-related death. Ninety-five percent of patients had complete closure of the TEF occurred in 95% of cases. Two patients had tracheal stenosis recurrence, and one patient had both TEF and tracheal stenosis recurrence. Two patients have indwelling silicone tracheal stents. CONCLUSIONS: Surgical treatment of TEF is effective. Nonetheless, morbidity and mortality are not negligible, even when performed at a referral center and after appropriate preoperative evaluation.

END-TO-END VERSUS END-TO-SIDE ANASTOMOSIS IN THE TREATMENT OF ESOPHAGEAL ATRESIA OR TRACHEO-ESOPHAGEAL FISTULA.

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.

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.

Chemocauterization with trichloroacetic acid in congenital and recurrent tracheoesophageal fistula: a minimally invasive treatment.

OBJECTIVE: Recurrent tracheoesophageal fistula (RTEF) is a serious complication after primary repair of esophageal atresia and tracheoesophageal fistula (EA/TEF). Treatment of RTEF involved an open surgery by thoracotomy. Technically it is a challenge with a high morbidity and mortality. Congenital tracheoesophageal fistula (CTEF) traditionally involved an open surgery by thoracotomy or cervicotomy. Many endoscopic techniques have been developed since the past decades: thoracoscopic or bronchoscopic approach for the treatment of RTEF and CTEF; nevertheless, optimal treatment is not still determined because of few numbers of patients, short-term follow-up, and different procedures. We report our experience and evaluated the efficacy in the chemocauterization of CTEF and RTEF, with the use of 50% trichloroacetic acid (TCA) as a technique minimally invasive. MATERIALS AND METHODS: From 2010 to 2014, fourteen patients with TEF (twelve RTEF and two CTEF) were selected for endoscopic management in two centers. Twelve patients had RTEF after primary repair of EA/TEF by thoracotomy approach, and two patients had CTEF in the upper pouch, diagnosed after EA/TEF (Type B) long gap, treated by thoracotomy and thoracoscopy, respectively. In all cases the diagnosis was confirmed by esophagram, bronchoscopy, and clinical evaluation. Under general anesthesia, a rigid pediatric bronchoscope with a 0° rod lens telescope and tele-monitoring was used to localize the TEF. Cotton soaked with 50% TCA was applied on the TEF during 30 s, and the procedure was repeated 3 times. The endoscopic treatment was performed monthly until TEF closure was achieved. RESULTS: RTEF and CTEF were closed in all patients. The mean number of procedure in each patient was 1.8. Closure of TEF was confirmed by esophagram, bronchoscopy, and clinical evaluation. There were a bacterial pneumonia and bronchospasm as postoperative complications. Median follow-up was 41 months (8-72). All of these TEF remain completely obliterated, and all patients are asymptomatic. CONCLUSION: Endoscopic management of congenital and recurrent TEF with the use of 50% TCA is as a minimally invasive, effective, simple and safe technique in these patients and avoids the morbidity of open surgery.

A treatment program for babies with esophageal atresia in Belize.

BACKGROUND: Children born with congenital anomalies in low- and middle-income countries often face a multitude of challenges. Access to pediatric surgical services is limited because of a lack of medical facilities, an adequate transportation system, and a lack of trained surgeons, anesthesiologists, and nurses, all of which leads to a high mortality rate. METHODS: This is a report of a 5-y collaborative effort between the World Pediatric Project, the Children's Hospital of Richmond at Virginia Commonwealth University, and multiple organizations within the country of Belize to provide care for infants born with esophageal atresia, with or without associated tracheoesophageal fistula. RESULTS: A total of six infants were transferred to our institution in Richmond, VA for operative correction of their esophageal atresia. CONCLUSIONS: Caring for infants with congenital anomalies can be challenging, especially children from low- and middle-income countries. Through collaboration between countries and nonprofit organizations, life-saving international care can be provided to children for these conditions.

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.