Perioperative Complications of Esophageal Atresia

Francesco Morini; Andrea Conforti; Pietro Bagolan

doi:10.1055/s-0038-1636941

European Journal of Pediatric Surgery, Table of Contents

Eur J Pediatr Surg 2018; 28(02): 133-140
DOI: 10.1055/s-0038-1636941

Review Article

Georg Thieme Verlag KG Stuttgart · New York

Perioperative Complications of Esophageal Atresia

Francesco Morini

¹Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy

,

Andrea Conforti

¹Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy

,

Pietro Bagolan

¹Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy

› Author Affiliations

Abstract

Current survival rate of infants with esophageal atresia with/without tracheoesophageal fistula (EA/TEF) exceeds 90% and great interest is dedicated to the long-term outcomes and complications. However, perioperative complications represent a significant burden to the EA/TEF infants and a technical challenge for the surgeon. In this review, we will focus on the most frequent perioperative complications specific of EA/TEF to describe their predisposing factors, possible preventive measures, and treatment options.

Keywords

anastomotic leak - chylothorax - recurrent fistula - thoracoscopy - vocal cord dysfunction

Full Text

References

References
1 Pedersen RN, Calzolari E, Husby S, Garne E. ; EUROCAT Working group. Oesophageal atresia: prevalence, prenatal diagnosis and associated anomalies in 23 European regions. Arch Dis Child 2012; 97 (03) 227-232
2 Nassar N, Leoncini E, Amar E. , et al. Prevalence of esophageal atresia among 18 international birth defects surveillance programs. Birth Defects Res A Clin Mol Teratol 2012; 94 (11) 893-899
3 Wang B, Tashiro J, Allan BJ. , et al. A nationwide analysis of clinical outcomes among newborns with esophageal atresia and tracheoesophageal fistulas in the United States. J Surg Res 2014; 190 (02) 604-612
4 Allin B, Knight M, Johnson P, Burge D. ; BAPS-CASS. Outcomes at one-year post anastomosis from a national cohort of infants with oesophageal atresia. PLoS One 2014; 9 (08) e106149
5 Sulkowski JP, Cooper JN, Lopez JJ. , et al. Morbidity and mortality in patients with esophageal atresia. Surgery 2014; 156 (02) 483-491
6 Kluth D. Atlas of esophageal atresia. J Pediatr Surg 1976; 11 (06) 901-919
7 Atzori P, Iacobelli BD, Bottero S. , et al. Preoperative tracheobronchoscopy in newborns with esophageal atresia: does it matter?. J Pediatr Surg 2006; 41 (06) 1054-1057
8 Garge S, Rao KL, Bawa M. The role of preoperative CT scan in patients with tracheoesophageal fistula: a review. J Pediatr Surg 2013; 48 (09) 1966-1971
9 Zani A, Eaton S, Hoellwarth ME. , et al. International survey on the management of esophageal atresia. Eur J Pediatr Surg 2014; 24 (01) 3-8
10 Lal DR, Gadepalli SK, Downard CD. , et al; Midwest Pediatric Surgery Consortium. Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2017; 52 (08) 1245-1251
11 Conforti A, Morini F, Bagolan P. Difficult esophageal atresia: trick and treat. Semin Pediatr Surg 2014; 23 (05) 261-269
12 Hall NJ, Wyatt M, Curry JI, Kiely EM. A standardised investigative strategy prior to revisional oesophageal surgery in children: high incidence of unexpected findings. J Pediatr Surg 2013; 48 (11) 2241-2246
13 Waterston DJ, Carter RE, Aberdeen E. Oesophageal atresia: tracheo-oesophageal fistula. A study of survival in 218 infants. Lancet 1962; 1 (7234): 819-822
14 Yagyu M, Gitter H, Richter B, Booss D. Esophageal atresia in Bremen, Germany--evaluation of preoperative risk classification in esophageal atresia. J Pediatr Surg 2000; 35 (04) 584-587
15 Maoate K, Myers NA, Beasley SW. Gastric perforation in infants with oesophageal atresia and distal tracheo-oesophageal fistula. Pediatr Surg Int 1999; 15 (01) 24-27
16 Kimble RM, Harding JE, Kolbe A. The vulnerable stomach in babies born with pure oesophageal atresia. Pediatr Surg Int 1999; 15 (07) 467-469
17 Rathod KK, Bawa M, Mahajan JK, Samujh R, Rao KL. Management of esophageal atresia with a tracheoesophageal fistula complicated by gastric perforation. Surg Today 2011; 41 (10) 1391-1394
18 Acer T, Karnak I, Yalçin S, Senocak ME. Why gastric perforation occurs in patients with isolated esophageal atresia: more vulnerable stomach?. Turk J Pediatr 2012; 54 (03) 312-316
19 Lobe TE, Rothenberg SS, Waldshmidt J, Stroedter L. Thoracoscopic repair of esophageal atresia in an infant: a surgical first. Pediatr Endosurg Innov Tech 1999; 3: 141-148
20 Bishay M, Giacomello L, Retrosi G. , et al. Decreased cerebral oxygen saturation during thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia in infants. J Pediatr Surg 2011; 46 (01) 47-51
21 Bishay M, Giacomello L, Retrosi G. , et al. Hypercapnia and acidosis during open and thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia: results of a pilot randomized controlled trial. Ann Surg 2013; 258 (06) 895-900
22 Tytgat SH, van Herwaarden MY, Stolwijk LJ. , et al. Neonatal brain oxygenation during thoracoscopic correction of esophageal atresia. Surg Endosc 2016; 30 (07) 2811-2817
23 Zani A, Lamas-Pinheiro R, Paraboschi I. , et al. Intraoperative acidosis and hypercapnia during thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia/tracheoesophageal fistula. Paediatr Anaesth 2017; 27 (08) 841-848
24 Neunhoeffer F, Warmann SW, Hofbeck M. , et al. Elevated intrathoracic CO₂ pressure during thoracoscopic surgery decreases regional cerebral oxygen saturation in neonates and infants-a pilot study. Paediatr Anaesth 2017; 27 (07) 752-759
25 Inoue M, Uchida K, Otake K. , et al. Thoracoscopic repair of congenital diaphragmatic hernia with countermeasures against reported complications for safe outcomes comparable to laparotomy. Surg Endosc 2016; 30 (03) 1014-1019
26 Knottenbelt G, Costi D, Stephens P, Beringer R, Davidson A. An audit of anesthetic management and complications of tracheo-esophageal fistula and esophageal atresia repair. Paediatr Anaesth 2012; 22 (03) 268-274
27 Kinottenbelt G, Skinner A, Seefelder C. Tracheo-oesophageal fistula (TOF) and oesophageal atresia (OA). Best Pract Res Clin Anaesthesiol 2010; 24 (03) 387-401
28 Chittmittrapap S, Spitz L, Kiely EM, Brereton RJ. Anastomotic leakage following surgery for esophageal atresia. J Pediatr Surg 1992; 27 (01) 29-32
29 Spitz L. Esophageal atresia: past, present, and future. J Pediatr Surg 1996; 31 (01) 19-25
30 Holland AJA, Fitzgerald DA. Oesophageal atresia and tracheo-oesophageal fistula: current management strategies and complications. Paediatr Respir Rev 2010; 11 (02) 100-106 , quiz 106–107
31 Sfeir R, Bonnard A, Khen-Dunlop N. , et al. Esophageal atresia: data from a national cohort. J Pediatr Surg 2013; 48 (08) 1664-1669
32 Lal DR, Gadepalli SK, Downard CD. , et al; Midwest Pediatric Surgery Consortium. Challenging surgical dogma in the management of proximal esophageal atresia with distal tracheoesophageal fistula: outcomes from the Midwest Pediatric Surgery Consortium. J Pediatr Surg 2017;
33 Chavin K, Field G, Chandler J, Tagge E, Othersen HB. Save the child's esophagus: management of major disruption after repair of esophageal atresia. J Pediatr Surg 1996; 31 (01) 48-51
34 Spitz L. Oesophageal atresia. Orphanet J Rare Dis 2007; 2: 24
35 Koivusalo AI, Pakarinen MP, Lindahl HG, Rintala RJ. Revisional surgery for recurrent tracheoesophageal fistula and anastomotic complications after repair of esophageal atresia in 258 infants. J Pediatr Surg 2015; 50 (02) 250-254
36 Tambucci R, Angelino G, De Angelis P. , et al. Anastomotic strictures after esophageal atresia repair: incidence, investigations, and management, including treatment of refractory and recurrent strictures. Front Pediatr 2017; 5: 120
37 Shah R, Varjavandi V, Krishnan U. Predictive factors for complications in children with esophageal atresia and tracheoesophageal fistula. Dis Esophagus 2015; 28 (03) 216-223
38 Krishnan U, Mousa H, Dall'Oglio L. , et al. ESPGHAN-NASPGHAN Guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with esophageal atresia-tracheoesophageal fistula. J Pediatr Gastroenterol Nutr 2016; 63 (05) 550-570
39 Vaghela MM, Mahajan JK, Sundram J, Bhardwaj N, Rao KLN. Role of glycopyrrolate in healing of anastomotic dehiscence after primary repair of esophageal atresia in a low resource setting-a randomized controlled study. J Pediatr Surg 2017; 52 (03) 420-423
40 Mathur S, Vasudevan SA, Patterson DM, Hassan SF, Kim ES. Novel use of glycopyrrolate (Robinul) in the treatment of anastomotic leak after repair of esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2011; 46 (03) e29-e32
41 Mencio MA, Ontiveros E, Burdick JS, Leeds SG. Use of a novel technique to manage gastrointestinal leaks with endoluminal negative pressure: a single institution experience. Surg Endosc 2018;
42 Bessone LN, Ferguson TB, Burford TH. Chylothorax. Ann Thorac Surg 1971; 12 (05) 527-550
43 Scottoni F, Fusaro F, Conforti A, Morini F, Bagolan P. Pleurodesis with povidone-iodine for refractory chylothorax in newborns: personal experience and literature review. J Pediatr Surg 2015; 50 (10) 1722-1725
44 Chick JFB, Gemmete JJ, Cline M, Srinivasa RN. Successful thoracic duct embolization for treatment of an iatrogenic left chylothorax in a neonate after repair of a tracheoesophageal fistula and esophageal atresia. J Vasc Interv Radiol 2017; 28 (09) 1325-1327
45 Ein SH, Stringer DA, Stephens CA, Shandling B, Simpson J, Filler RM. Recurrent tracheoesophageal fistulas seventeen-year review. J Pediatr Surg 1983; 18 (04) 436-441
46 Ghandour KE, Spitz L, Brereton RJ, Kiely EM. Recurrent tracheo-oesophageal fistula: experience with 24 patients. J Paediatr Child Health 1990; 26 (02) 89-91
47 Burford JM, Dassinger MS, Copeland DR, Keller JE, Smith SD. Repair of esophageal atresia with tracheoesophageal fistula via thoracotomy: a contemporary series. Am J Surg 2011; 202 (02) 203-206
48 Friedmacher F, Kroneis B, Huber-Zeyringer A. , et al. Postoperative complications and functional outcome after esophageal atresia repair: results from longitudinal single-center follow-up. J Gastrointest Surg 2017; 21 (06) 927-935
49 Aworanti O, Awadalla S. Management of recurrent tracheoesophageal fistulas: a systematic review. Eur J Pediatr Surg 2014; 24 (05) 365-375
50 Smithers CJ, Hamilton TE, Manfredi MA. , et al. Categorization and repair of recurrent and acquired tracheoesophageal fistulae occurring after esophageal atresia repair. J Pediatr Surg 2017; 52 (03) 424-430
51 Tieder JS, Bonkowsky JL, Etzel RA. , et al; SUBCOMMITTEE ON APPARENT LIFE THREATENING EVENTS. Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants. Pediatrics 2016; 137 (05) e20160591
52 Meier JD, Sulman CG, Almond PS, Holinger LD. Endoscopic management of recurrent congenital tracheoesophageal fistula: a review of techniques and results. Int J Pediatr Otorhinolaryngol 2007; 71 (05) 691-697
53 Morini F, Iacobelli BD, Crocoli A. , et al. Symptomatic vocal cord paresis/paralysis in infants operated on for esophageal atresia and/or tracheo-esophageal fistula. J Pediatr 2011; 158 (06) 973-976
54 Woo S, Lau S, Yoo E, Shaul D, Sydorak R. Thoracoscopic versus open repair of tracheoesophageal fistulas and rates of vocal cord paresis. J Pediatr Surg 2015; 50 (12) 2016-2018
55 Oestreicher-Kedem Y, DeRowe A, Nagar H, Fishman G, Ben-Ari J. Vocal fold paralysis in infants with tracheoesophageal fistula. Ann Otol Rhinol Laryngol 2008; 117 (12) 896-901
56 Qi BQ, Merei J, Farmer P. , et al. The vagus and recurrent laryngeal nerves in the rodent experimental model of esophageal atresia. J Pediatr Surg 1997; 32 (11) 1580-1586
57 Bargy F, Houette A, Barbet P. The left recurrent laryngeal nerve at birth: anatomy and surgical applications. Surg Radiol Anat 1986; 8 (04) 245-250
58 Robertson JR, Birck HG. Laryngeal problems following infant esophageal surgery. Laryngoscope 1976; 86 (07) 965-970
59 Conforti A, Iacusso C, Valfrè L, Trozzi M, Bottero S, Bagolan P. ; Laryngotracheal Team Bambino Gesù Children's Hospital. Cervical repair of congenital tracheoesophageal fistula: Complications lurking!. J Pediatr Surg 2016; 51 (10) 1623-1626
60 Zani A, Jamal L, Cobellis G. , et al. Long-term outcomes following H-type tracheoesophageal fistula repair in infants. Pediatr Surg Int 2017; 33 (02) 187-190
61 Vanamo K, Berg E, Kokki H, Tikanoja T. Video-assisted thoracoscopic versus open surgery for persistent ductus arteriosus. J Pediatr Surg 2006; 41 (07) 1226-1229
62 Sarkaria IS, Finley DJ, Bains MS. , et al. Chylothorax and recurrent laryngeal nerve injury associated with robotic video-assisted mediastinal lymph node dissection. Innovations (Phila) 2015; 10 (03) 170-173
63 Odegard KC, Kirse DJ, del Nido PJ. , et al. Intraoperative recurrent laryngeal nerve monitoring during video-assisted throracoscopic surgery for patent ductus arteriosus. J Cardiothorac Vasc Anesth 2000; 14 (05) 562-564
64 Givens DJ, Buchmann LO, Park AH. A novel surgical management of hypopharyngeal branchial anomalies. Int J Pediatr Otorhinolaryngol 2015; 79 (04) 579-583
65 King EF, Blumin JH. Vocal cord paralysis in children. Curr Opin Otolaryngol Head Neck Surg 2009; 17 (06) 483-487