Os diferentes tipos de atresia de esôfago são anomalias freqüência na atresia de esôfago sem fístula. A .. Doenças gastrenterológicas em pediatria. IS. Cirurgia Pediátrica, H Pediátrico Carmona da Mota, CH e Universitário de frequente foi laqueação de fístula e esófago-esofagostomia primária (n=27). Mortalidad en pacientes con atresia de esófago: influencia del peso al nacer y de la malformación cardíacaMortality in patients with esophageal atresia.
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AltPDF. Congenital esophageal stenosis owing to tracheobronchial remnants Revista Paulista de Pediatria. Sociedade De Pediatria De Sao Paulo . submitted to surgical repair of esophageal atresia with distal tracheoesophageal fistula .. Atribuiu-se o primeiro relato de estenose congênita do esôfago (ECE) a Frey e. IVGastroenterologista e endoscopista pediátrica, Centro Geral de Pediatria, . As estenoses secundárias à correção cirúrgica de atresia de esôfago, em geral, . IIUniversidade Federal de São Paulo, Departamento de Pediatria, Disciplina de A estenose secundária à correção cirúrgica de atresia de esôfago ocorre.
Garza JM, Kaul A. Pediatr Clin N Am ; Am J Gastroenterol ; Dranove JE. New technologies for the diagnosis of gastroesophageal reflux disease. Pediatrics in Review ; Gastro esophageal reflux in infancy and childhood. Pediatric Annals ; Gastroesophageal reflux disease: esophageal impedance versus pH monitoring.
Acta Pediatrica ; Jounal Pediatric Gastroenterology and Nutrition ; All patients were submitted to an open repair through thoracotomy and extrapleural was the preferred surgical approach.
Median age at corrective surgery was 1. Surgical repair was performed earlier in patients with non long-gap OA with a median of 1 day in this group minimum 1; maximum 4 days vs. The median length of ventilation after surgery was 4 days P 2; P 5 , being longer in long-gap OA patients 2 days in non long-gap OA vs. Table 3 shows each early complication distribution in non long-gap and long-gap OA patients.
Birth weight and gestational age were not associated with PICU length of stay. There was no mortality during PICU stay. It could be related to the small size of our sample that represents only the central region of Portugal. There is no apparent explanation for this, but a similar pattern is also seen in other congenital anomalies More than half of the patients were preterm, what could be related to the associated polyhydramnios.
Less than a quarter of the cases had a prenatal diagnosis.
In combination with polyhydramnios the sensitivity is higher, but isolated polyhydramnios is a weak signal for OA. Given this, the accuracy of antenatal ultrasound appears to be greater in isolated OA 3 , what could explain the low prenatal detection rate verified in our study with a predominance of OA with TOF. Nevertheless, an early postnatal diagnosis, in the first 72 hours of life, was made in all cases.
An attempt to introduce a gastric tube immediately after birth might be made if any antenatal suspicion was present. As described in literature, additional malformations were detected in more than half of the cases, mostly cardiac defects.
As recommended, all patients had an echocardiogram prior to surgery. Besides allowing detection of a cardiac defect that may need intervention, the echocardiogram also defines any structural anomaly of the heart or great blood vessels like a right-sided aortic arch which determinates the side for surgical approach 1,3. Some authors recommend performing a preoperative bronchoscopy to exclude an upper pouch fistula which is times more common in the gasless abdomen OA 3.
Type C OA was the most common, followed by type A, which is in agreement with literature 12, Primary oesophageal anastomosis with fistula ligation was the most common surgical option, reflecting the higher prevalence of type C and non long-gap OA. Long-gap OA correction is a major surgical and medical challenge and there are many treatment options described in literature.
In this study, delayed oesophageal anastomosis was often preceded by Foker procedure application of graduated tension on the oesophageal ends 1,3,8,14, Consequently, the age at corrective surgery was different according to gap length and it was lower in the group of non long-gap OA.
As we report, a primary surgical repair in neonatal period is possible in the majority of patients with type C OA, including the ones with long-gap OA.
In opposition to that, primary anastomosis in neonatal period is exceptional in type A OA. In our study, only one type A OA was submitted to a primary repair, but after an awaiting period of time. Median length of ventilation after surgery was higher in longgap OA patients, which was related to an higher frequency of anastomotic tension in this group. The gap between the two ends of the oesophagus is a critical factor in determining tension at the anastomotic point as it has been shown in some studies When the oesophageal anastomosis is performed under tension, many centers recommend that the infant should be electively paralyzed and mechanically ventilated for a variable period of time 3.
According to our experience, this time should be as shorter as possible in order to protect both, the anastomosis and the lung. Early postoperative complications were common, especially anastomotic leak, sepsis and pneumothorax, what may reflect the complexity of the surgery performed.
The Spitz classification has proved to be a useful tool in determining long-term outcome 3 , but it seems not to influence the risk of early complications in our study. Shortly after corrective surgery, gap length and associated malformations seemed to be a better predictor of PICU length of stay than the Spitz classification, probably due to improvement of care of low birth weight neonates. Our study failed to achieve statistically significant difference in occurrence of early complications according to gap length.
Recently, other authors concluded that long-gap was a major predictor of post-repair complications Esophagoplasty for caustic esophageal burns in children. Pediatr Surg Int. Guidelines on the use of oesophageal dilatation in clinical practice. Benign esophageal strictures in toddlers and pre-school children. Results of endoscopic dilation.
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Balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia. Br J Radiol. Clinical characteristics and management of congenital esophageal stenosis: a report on 14 cases. Perforation complicating balloon dilation of esophageal strictures in infants and children.
Endoscopic manifestations of gastroesophageal reflux disease in patients between 18 months and 25 years without neurological deficits. Am J Gastroenterol.