Search

Objective To summarize the clinical efficacy of programmed management for H-type congenital tracheoesophageal fistula (H-TEF). Methods From March 2017 to March 2022, clinical data were retrospectively reviewed for 10 H-TEF children under programmed management.Six neonates developed recurrent cough after feeding and 4 infants had recurrent pneumonia.One case was associated with congenital heart disease and another had hemivertebra deformity of thoracic vertebra.After a definite diagnosis was confirmed by esophagography and/or fiberbronchoscope, gastric tube feeding was initiated.After inflammatory parameters normalized completely or partially and pneumonic change disappeared on chest film, a catheter was placed in fistula under a guidance of fiberbronchoscope.The position of fistula was confirmed by bedside radiography; H-TEF was repair through a cervical approach when fistula was located above T2 level and thoracoscopically below T2. Results Seven cases were confirmed by esophagography and 3 cases by fiberbronchoscope.Catheter was successfully deployed in fistula in all cases before surgery.Seven cases of fistula above T2 were repaired through a right cervical route and 3 cases of fistula below T2 underwent thoracoscopy.Feeding through a gastric tube resumed the next day and esophagography 1 week later.There was no leakage or recurrence during a follow-up period of (8-60) month.Three cases of hoarseness occurred after cervical surgery and recovered at (1-6) month.No dysphagia or recurrence was noted. Conclusion An integrated strategy for H-TEF yields satisfactory outcomes under programmed management. [ABSTRACT FROM AUTHOR]

Too many types of congenital esophageal atresia with a great diversity and variability bring dilemmas to clinical management. In clinical cases of first-stage end-to-end esophageal anastomosis, operative failure and error occur frequently due to inaccurate preoperative examinations and evaluations. Subsequent treatment becomes extremely difficult so that therapeutic efficacy is poor. Subsequent complications and sequelae adversely affect the quality of life. Based upon an etiological analysis of actual clinical cases, this review proposed practical and feasible clinical measures of avoid surgical failures and operative errors to improve the therapeutic outcomes of esophageal atresia. [ABSTRACT FROM AUTHOR]

Objective To summarize clinical experience of elongating esophageal segments through Bougienage stretching technique for pure esophageal atresia (EA) to achieve delayed primary anastomosis. Methods From January 2015 to December 2018, 32 children of pure EA underwent Bougienage stretching technique before esophageal anastomosis. Results All of them survived postoperatively.Initial assessment revealed a proximal-distal length of (5.5±1.5)cm.After elongating for (68.2±41.3) days, the length shortened to (-0.5±0.9)cm.Reconstruction was performed by thoracoscopy (n=27) and thoracotomy (n=5). The postoperative complications included anastomotic leakage (n=9), stenosis (n=30), hiatal hernia (n=9), malnutrition (n=8) and developmental delay (n=6). Conclusion Bougienage stretching technique for pure EA is feasible with satisfactory clinical outcomes with autogenous esophagus for primary anastomosis.It is ideal for restoring esophageal function and enhancing quality-of-life of EA children. [ABSTRACT FROM AUTHOR]