Christoph S Nabzdyk1, Bill Chiu2, Carl-Christian Jackson1, Walter J Chwals1. 1. Division of Pediatric Surgery, Department of Surgery, Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, MA, United States. 2. Division of Pediatric Surgery, Department of Surgery, Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, MA, United States. Electronic address: bchiu@tuftsmedicalcenter.org.
Abstract
INTRODUCTION: Patients with combined esophageal atresia (EA), tracheoesophageal fistula (TEF), and duodenal atresia (DA) pose a rare management challenge. PRESENTATION OF CASE: Three patients with combined esophageal atresia (EA), tracheoesophageal fistula (TEF), and duodenal atresia safely underwent a staged approach inserting a gastrostomy tube and repairing the EA/TEF first followed by a duodenoduodenostomy within one week. None of the patients suffered significant pre- or post-operative complications and our follow-up data (between 12 and 24 months) suggest that all patients eventually outgrow their reflux and respiratory symptoms. DISCUSSION: While some authors support repair of all defects in one surgery, we recommend a staged approach. A gastrostomy tube is placed first for gastric decompression before TEF ligation and EA repair can be safely undertaken. The repair of the DA can then be performed within 3-7 days under controlled circumstances. CONCLUSION: A staged approach of inserting a gastrostomy tube and repairing the EA/TEF first followed by a duodenoduodenostomy within one week resulted in excellent outcomes.
INTRODUCTION:Patients with combined esophageal atresia (EA), tracheoesophageal fistula (TEF), and duodenal atresia (DA) pose a rare management challenge. PRESENTATION OF CASE: Three patients with combined esophageal atresia (EA), tracheoesophageal fistula (TEF), and duodenal atresia safely underwent a staged approach inserting a gastrostomy tube and repairing the EA/TEF first followed by a duodenoduodenostomy within one week. None of the patients suffered significant pre- or post-operative complications and our follow-up data (between 12 and 24 months) suggest that all patients eventually outgrow their reflux and respiratory symptoms. DISCUSSION: While some authors support repair of all defects in one surgery, we recommend a staged approach. A gastrostomy tube is placed first for gastric decompression before TEF ligation and EA repair can be safely undertaken. The repair of the DA can then be performed within 3-7 days under controlled circumstances. CONCLUSION: A staged approach of inserting a gastrostomy tube and repairing the EA/TEF first followed by a duodenoduodenostomy within one week resulted in excellent outcomes.
Authors: Mikael Petrosyan; Joaquin Estrada; Catherine Hunter; Russell Woo; James Stein; Henri R Ford; Dean M Anselmo Journal: J Pediatr Surg Date: 2009-12 Impact factor: 2.545
Authors: Mariusz Sroka; Robin Wachowiak; Marcin Losin; Agnieszka Szlagatys-Sidorkiewicz; Piotr Landowski; Piotr Czauderna; John Foker; Holger Till Journal: Eur J Pediatr Surg Date: 2013-02-01 Impact factor: 2.191