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]

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]

Objective To evaluate the clinical efficacy and prognosis of neonatal primary anoplasty through a retrospective comparison of the results of defecation function and anorectal manometry after one-stage anoplasty. Methods From January 2006 to August 2019,a total of 132 children with intermediate anorectal malformation were recruited as study subjects. All of them underwent modified posterior sagittal anorectoplasty (mini-Peña).According to operative period, they were divided into two groups. Group 1 included 22 children diagnosed with intermediate anorectal malformation during neonatal period undergoing primary anoplasty. And group 2 had 110 children undergoing traditional staged anoplasty. Both groups were followed up for 15 years to evaluate long-term defecation functions and complications. During follow-ups, Rintala score was employed for evaluating postoperative defecation function and the grades were excellent, good, moderate and poor. All cases were examined by anorectal manometry, including anal resting pressure, anal length, internal sphincter resting pressure and length, external sphincter resting pressure and length and rectoanal inhibitory reflex (RAIR),etc. Results No significant inter-group differences in gender ratio or birth weight (P>0.05).Duration of postoperative hospital stay was longer in group 1 than that in group 2[(17.1±3.9) vs.(10.4±3.4) d, P<0.05].Hospital stay and operative duration were markedly shorter in group 1 than those in group 2[(19.6±5.5) vs.(37.5±10.7) days;(128.9±29.0) vs.(287.9±61.2) min, P<0.05].No significant inter-group difference existed in anal length or internal/external sphincter length(P>0.05).Anal resting pressure, internal sphincter resting pressure and external sphincter resting pressure of group 1 were higher than those in group 2[(53.8±15.5) vs.(36.7±10.4) mmHg;(53.5±15.1) vs.(34.6 ±8.7) mmHg;(45.7±16.9) vs.(33.9±11.8) mmHg, P<0.05].Extraction rate of rectal inhibitory reflex was significantly higher in group 1 than that in group 2 (66.7% vs.0%,P<0.05).No significant statistical difference existed in other anorectal pressures(P>0.05). Rintala score of two groups showed no obvious difference in rate of excellent/good(83.3% vs.88.0%,P>0.05).(83.3% vs.88.0%,P>0.05).No significant inter-group differences existed in the incidence of constipation, soiling or postoperative complications(25% vs.28.0%;16.7% vs.16.0%;33.3% vs.50.7%,P>0.05).Conclusion Neonates with intermediate anorectal malformations undergoing one-stage anoplasty can also have good postoperative stool control ability. Early one-stage anoplasty may avoid operative wound and closure of stoma. [ABSTRACT FROM AUTHOR]