Andreas Schmidt1, Florian Obermayr2, Justus Lieber3, Christian Gille4, Frank Fideler5, Joerg Fuchs6. 1. Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany. Electronic address: andreas.schmidt@med.uni-tuebingen.de. 2. Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany; Department of Pediatric Surgery, University Hospital, Philipps University Marburg, Baldingerstrasse, 35043 Marburg, Germany. Electronic address: Florian.Obermayr@uk-gm.de. 3. Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany. Electronic address: Justus.Lieber@med.uni-tuebingen.de. 4. Department of Neonatology, University Children's Hospital, Eberhard Karls University Tuebingen, Calwer-Strasse 7, 72076 Tuebingen, Germany. Electronic address: Christian.Gille@med.uni-tuebingen.de. 5. Department of Anesthesiology and Intensive Care Medicine, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany. Electronic address: Frank.Fideler@med.uni-tuebingen.de. 6. Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany. Electronic address: Joerg.Fuchs@med.uni-tuebingen.de.
Abstract
PURPOSE: The optimal surgical management of extremely (ELBW) and very low-birth-weight (VLBW) neonates with esophageal atresia and distal tracheoesophageal fistula (EA/TEF) (Gross type C) is still debated. The aim of this study was to evaluate the surgical outcome of primary repair in these patients and compare it to ≥1500g neonates. METHODS: Medical records of neonates with repaired EA from 2002 to 2016 were reviewed. RESULTS: 4 ELBW, 7 VLBW, and 24 ≥1500g infants had type C EA/TEF and underwent primary repair. Anastomotic leakage occurred in 0% ELBW, 0% VLBW and 8.3% ≥1500g patients and anastomotic stricture in 25% ELBW, 28.5% VLBW and 37.5% ≥1500g patients. 50% ELBW, 14.2% VLBW and 20.8% ≥1500g patients underwent secondary fundoplication. One patient of the VLBW group and one patient of the ≥1500g group died postoperatively of causes not related to EA/TEF. CONCLUSIONS: In extremely and very low-birth-weight neonates with type C EA/TEF surgical outcome after primary repair is comparable to the outcome in ≥1500g neonates. Primary repair can be performed in most of these patients and staged repair can be restricted to unstable patients. LEVEL OF EVIDENCE: Treatment study level III.
PURPOSE: The optimal surgical management of extremely (ELBW) and very low-birth-weight (VLBW) neonates with esophageal atresia and distal tracheoesophageal fistula (EA/TEF) (Gross type C) is still debated. The aim of this study was to evaluate the surgical outcome of primary repair in these patients and compare it to ≥1500g neonates. METHODS: Medical records of neonates with repaired EA from 2002 to 2016 were reviewed. RESULTS: 4 ELBW, 7 VLBW, and 24 ≥1500g infants had type C EA/TEF and underwent primary repair. Anastomotic leakage occurred in 0% ELBW, 0% VLBW and 8.3% ≥1500g patients and anastomotic stricture in 25% ELBW, 28.5% VLBW and 37.5% ≥1500g patients. 50% ELBW, 14.2% VLBW and 20.8% ≥1500g patients underwent secondary fundoplication. One patient of the VLBW group and one patient of the ≥1500g group died postoperatively of causes not related to EA/TEF. CONCLUSIONS: In extremely and very low-birth-weight neonates with type C EA/TEF surgical outcome after primary repair is comparable to the outcome in ≥1500g neonates. Primary repair can be performed in most of these patients and staged repair can be restricted to unstable patients. LEVEL OF EVIDENCE: Treatment study level III.
Authors: Laura Antonia Ritz; Anke Widenmann-Grolig; Stefan Jechalke; Sandra Bergmann; Dietrich von Schweinitz; Eberhard Lurz; Jochen Hubertus Journal: Front Pediatr Date: 2020-11-17 Impact factor: 3.418