Victoria K Pepper1, Laura A Boomer1, Arlyne K Thung2, Jonathan M Grischkan3, Karen A Diefenbach1. 1. 1 Department of Pediatric Surgery, Nationwide Children's Hospital , Columbus, Ohio. 2. 2 Department of Anesthesiology, Nationwide Children's Hospital , Columbus, Ohio. 3. 3 Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital , Columbus, Ohio.
Abstract
INTRODUCTION: Use of a Fogarty catheter for emergent occlusion of tracheoesophageal fistulas (TEFs) has been described for use in unstable neonates. Our purpose was to describe a case series of elective Fogarty catheter occlusion of the TEF. MATERIALS AND METHODS: A formal operative laryngoscopy and rigid bronchoscopy were performed with Fogarty catheter placement into the fistula before surgical intervention. The balloon was inflated and gentle traction provided occlusion of the tract. An endotracheal tube was then placed in a midtracheal location irrespective of fistulous tract location. The Fogarty catheter was removed at the time of fistula ligation. RESULTS: Six patients underwent Fogarty catheter occlusion of the TEF at the time of repair. The average gestational age was 38 ± 2 weeks and birth weight was 2499 ± 399 g. Associated anomalies or comorbidities were present in 2 of 6 patients (33%). Five patients (83%) had an esophageal atresia with distal TEF, all of whom underwent surgical intervention before day of life (DOL) 2. Of these patients, 3 were performed thoracoscopically, 1 was converted from thoracoscopic to open, and 1 was initiated as an open procedure. One patient had an H-type fistula, which was repaired through a cervical approach on DOL 48. Average time required for both bronchoscopy and Fogarty placement was 10 ± 2 minutes. There were no complications associated with Fogarty catheter placement and catheter dislodgement did not occur during any of the procedures. CONCLUSION: Elective Fogarty catheter occlusion of TEF can be performed safely and expeditiously, alleviating many perioperative challenges of TEF.
INTRODUCTION: Use of a Fogarty catheter for emergent occlusion of tracheoesophageal fistulas (TEFs) has been described for use in unstable neonates. Our purpose was to describe a case series of elective Fogarty catheter occlusion of the TEF. MATERIALS AND METHODS: A formal operative laryngoscopy and rigid bronchoscopy were performed with Fogarty catheter placement into the fistula before surgical intervention. The balloon was inflated and gentle traction provided occlusion of the tract. An endotracheal tube was then placed in a midtracheal location irrespective of fistulous tract location. The Fogarty catheter was removed at the time of fistula ligation. RESULTS: Six patients underwent Fogarty catheter occlusion of the TEF at the time of repair. The average gestational age was 38 ± 2 weeks and birth weight was 2499 ± 399 g. Associated anomalies or comorbidities were present in 2 of 6 patients (33%). Five patients (83%) had an esophageal atresia with distal TEF, all of whom underwent surgical intervention before day of life (DOL) 2. Of these patients, 3 were performed thoracoscopically, 1 was converted from thoracoscopic to open, and 1 was initiated as an open procedure. One patient had an H-type fistula, which was repaired through a cervical approach on DOL 48. Average time required for both bronchoscopy and Fogarty placement was 10 ± 2 minutes. There were no complications associated with Fogarty catheter placement and catheter dislodgement did not occur during any of the procedures. CONCLUSION: Elective Fogarty catheter occlusion of TEF can be performed safely and expeditiously, alleviating many perioperative challenges of TEF.