Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Pediatric Surgery 10 Esophageal Atresia Tracheo Esophageal Fistula PPT-Powerpoint Presentations and lecture notes
ESOPHAGEAL ATRESIA
TRACHEO-ESOPHAGEAL FISTULA
GROSS CLASSIFICATION
Gross classification of anatomic patterns of esophageal atresia.
A, Esophageal atresia without a tracheoesophageal fistula. This malformation
is almost invariably associated with a "long gap."
B, Atresia with a proximal tracheoesophageal fistula. It is an uncommon anomaly; the abdomen
is airless, and the diagnosis may be missed unless contrast studies or endoscopy is performed.
C, Esophageal atresia with a distal tracheoesophageal fistula, the most frequently encountered
form of esophageal anomaly.
D, Atresia with a double (proximal and distal) fistula. Though rare, this form is found more
often than original y thought.
E, Tracheoesophageal fistula without atresia (H-type fistula). This anomaly may be missed in the
newborn period because swal owing is possible. It is associated with recurrent cough,
pneumonia, and abdominal distention.
F, Esophageal stenosis.
Incidence of Various Esophageal Atresia--
Tracheoesophageal Fistula Anomalies
1. Esophageal atresia with a distal tracheoesophageal fistula
84%C
2. Esophageal atresia without tracheoesophageal fistula 6%A
3. Tracheoesophageal fistula without esophageal atresia 4%E
4. Esophageal atresia with a fistula to both pouches 1%D
5. Esophageal atresia with a proximal tracheoesophageal fistula
5%B
Waterston Risk Groups and
Current Survival Figures
Group Survival (%) Waterston Classification
A 100 Birth weight > 2500 g and otherwise healthy
B 85 Birth weight 2000-2500 g and well or higher
weight with moderate associated anomalies
(noncardiac anomalies plus patent ductus
arteriosus, ventricular septal defect, and atrial
septal defect)
C 65 Birth weight < 2000 g or higher with severe
associated cardiac anomalies
Okamoto modification of the Spitz Classification:
Predictors of Survival in Cases of Esophageal Atresia
Class Description Risk Survival
Class I No major cardiac anomaly, BW >2000 g Low 100%
Class II No major cardiac anomaly, BW < 2000 g Moderate 81%
Class II Major cardiac anomaly, BW >2000 g Relatively high 72%
Class IV Major cardiac anomaly, BW < 2000 g High 27%
ASSOCIATED ANOMALIES
Incidence of Associated Anomalies
? Cardiovascular 24%
? Genitourinary 21%
? Gastrointestinal 21%
? Musculoskeletal 14%
? Central nervous system 7%
? VACTERL association 20%
? Overall incidence 50%-70%
ANTENATAL suspected/ possibility
? Maternal polyhydramnios
? Absent stomach bubble (Pure EA)
? Maternal Ultrasound/ Fetal MRI
DIAGNOSIS
PRE-OP MANAGEMENT
? Oxygen by hood
? Mechanical ventilation support
? Mucus Suction by Replogle tube/ mucus
sucker/ low pressure suction
? Vitals monitoring (T/P/R)
? Temperature maintenance (incubators)
? Rule out associated anomalies (VACTERL)
? I V Fluids, Antibiotics and Inotropic support
? Routine blood investigations
(CBC/KFT/CRP/blood culture if sepsis +)
SURGERY
? Position: Right Posterolateral thoracotomy
? Approach: Extraplueral (preferred)/ Transplueral
? Surgery:
v Type B,C,D : Trache-oesophageal fistula ligation and end to end
anastomosis
v Type A: Cervical esophagostomy + Feeding gastrostomy; later
esophageal replacement surgery
v Type E: Fistula ligation through cervical approach
Long Gap EA
? Occasionally in infants with EA-TEF, the upper pouch is high
and the distance between the upper and lower esophageal
segments limits the ability to easily complete end-to-end
esophago-esophagostomy with acceptable tension.
? Surgical Maneuvers in Long-Gap Esophageal Atresia
During the Initial Procedure:
? Anastomosis under tension
? Tension-relieving procedures
? Flap technique
? Suture fistula
Delayed Primary Anastomosis:
? With bougienage: proximal,proximal and distal,magnetic
? Without bougienage
Long Gap EA
Esophageal lengthening techniques:
?Flaps,
?Spiral / Circular myotomy
?Gastric division
?Traction sutures- Foker's/ Kimura extrathoracic
?Transmediastinal "Thread"
?With and without "olives"
?Kato technique
Esophageal Replacement:
Colonic interposition
Gastric tube esophagoplasty
Jejunal interposition
Gastric transposition
PREDICTORS OF OUTCOME
? twin birth,
? preoperative intubation,
? birth weight less than 2500 g,
? long-gap atresia,
? Anastomotic leak,
? postoperative intubation longer than 4 days,
? and inability to feed at the end of 1 month
COMPLICATIONS
Early
? Anastomotic leak (13-16%)
? Anastomotic stricture (upto 80%)
? Recurrent tracheoesophageal Fistula (3-14%)
Late
? GERD (30-70%)
? Tracheomalacia (10-25%)
? Respiratory disease,
? Disordered esophageal peristalsis.
This post was last modified on 08 April 2022