Carmen Dingemann1, Simon Eaton2, Gunnar Aksnes3, Pietro Bagolan4, Kate M Cross5, Paolo De Coppi2,5, JoAnne Fruithof6, Piergiorgio Gamba7, Steffen Husby8, Antti Koivusalo9, Lars Rasmussen10, Rony Sfeir11, Graham Slater12, Jan F Svensson13, David C Van der Zee14, Lucas M Wessel15, Anke Widenmann-Grolig16, Rene Wijnen17, Benno M Ure1. 1. Department of Pediatric Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany. 2. Department of Paediatric Surgery and Metabolic Biochemistry, UCL Great Ormond Street Institute of Child Health, London, United Kingdom. 3. Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway. 4. Department of Medical and Surgical Neonatology, Bambino Gesu Children's Research Hospital, Rome, Italy. 5. Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, United Kingdom. 6. Esophageal Atresia and Tracheo-Esophageal Fistula Support Federation and-VOKS, Lichtenvoorde, The Netherlands. 7. Department of Pediatric Surgery, University of Padua, Padua, Italy. 8. Department of Pediatric Gastroenterology, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark. 9. Department of Pediatric Surgery, University of Helsinki, Children's Hospital, Helsinki, Finland. 10. Department of Pediatric Surgery, Odense University hospital, Odense, Denmark. 11. Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Lille, Lille, France. 12. Esophageal Atresia and Tracheo-Esophageal Fistula Support Federation and-TOFS, Nottingham, United Kingdom. 13. Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden. 14. Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. 15. Department of Pediatric Surgery, University of Mannheim, Medical Faculty of Heidelberg, Mannheim, Germany. 16. Esophageal Atresia and Tracheo-Esophageal Fistula Support Federation and KEKS, Stuttgart, Germany. 17. Department of Pediatric Surgery, Erasmus MC Sophia Ringgold standard institution, Rotterdam, The Netherlands.
Abstract
INTRODUCTION: Many aspects of the management of esophageal atresia (EA) and tracheoesophageal fistula (TEF) are controversial and the evidence for decision making is limited. Members of the European Reference Network for Rare Inherited Congenital Anomalies (ERNICA) conducted a consensus conference on the surgical management of EA/TEF based on expert opinions referring to the latest literature. MATERIALS AND METHODS: Nineteen ERNICA representatives from nine European countries participated in the conference. The conference was prepared by item generation, item prioritization by online survey, formulation of a final list containing the domains diagnostics, preoperative, operative, and postoperative management, and literature review. The 2-day conference was held in Berlin in October 2018. Anonymous voting was conducted via an internet-based system. Consensus was defined when 75% of the votes scored 6 to 9. RESULTS: Fifty-two items were generated with 116 relevant articles of which five studies (4.3%) were assigned as level-1evidence. Complete consensus (100%) was achieved on 20 items (38%), such as TEF closure by transfixing suture, esophageal anastomosis by interrupted sutures, and initiation of feeding 24 hours postoperatively. Consensus ≥75% was achieved on 37 items (71%), such as routine insertion of transanastomotic tube or maximum duration of thoracoscopy of 3 hours. Thirteen items (25%) were controversial (range of scores, 1-9). Eight of these (62%) did not reach consensus. CONCLUSION: Participants of the conference reached significant consensus on the management of patients with EA/TEF. The consensus may facilitate standardization and development of generally accepted guidelines. The conference methodology may serve as a blueprint for further conferences on the management of congenital malformations in pediatric surgery. Georg Thieme Verlag KG Stuttgart · New York.
INTRODUCTION: Many aspects of the management of esophageal atresia (EA) and tracheoesophageal fistula (TEF) are controversial and the evidence for decision making is limited. Members of the European Reference Network for Rare Inherited Congenital Anomalies (ERNICA) conducted a consensus conference on the surgical management of EA/TEF based on expert opinions referring to the latest literature. MATERIALS AND METHODS: Nineteen ERNICA representatives from nine European countries participated in the conference. The conference was prepared by item generation, item prioritization by online survey, formulation of a final list containing the domains diagnostics, preoperative, operative, and postoperative management, and literature review. The 2-day conference was held in Berlin in October 2018. Anonymous voting was conducted via an internet-based system. Consensus was defined when 75% of the votes scored 6 to 9. RESULTS: Fifty-two items were generated with 116 relevant articles of which five studies (4.3%) were assigned as level-1evidence. Complete consensus (100%) was achieved on 20 items (38%), such as TEF closure by transfixing suture, esophageal anastomosis by interrupted sutures, and initiation of feeding 24 hours postoperatively. Consensus ≥75% was achieved on 37 items (71%), such as routine insertion of transanastomotic tube or maximum duration of thoracoscopy of 3 hours. Thirteen items (25%) were controversial (range of scores, 1-9). Eight of these (62%) did not reach consensus. CONCLUSION:Participants of the conference reached significant consensus on the management of patients with EA/TEF. The consensus may facilitate standardization and development of generally accepted guidelines. The conference methodology may serve as a blueprint for further conferences on the management of congenital malformations in pediatric surgery. Georg Thieme Verlag KG Stuttgart · New York.
Authors: H Thakkar; D M Mullassery; S Giuliani; S Blackburn; K Cross; J Curry; Paolo De Coppi Journal: Pediatr Surg Int Date: 2021-02-07 Impact factor: 1.827