1/21. Gastrojejunal interposition for esophageal replacement.The main considerations in replacing the esophagus are to avoid postoperative necrosis of all or part of the graft, leakage or stenosis of the anastomoses, and complications related to acid-peptic or alkaline reflux. A 5-year-old boy, after two unsuccessful thoracic operations for atresia and then stenosis of the esophagus, underwent resection of the esophagus because of duodeno-gastroesophageal reflux. The continuity of the alimentary tract was restored by gastrojejunal interposition. We recommend this method of reconstruction when the esophago-gastrostoma is created in the chest, and the possibility of alkaline reflux must be considered.- - - - - - - - - - ranking = 1keywords = atresia (Clic here for more details about this article) |
2/21. Primary anastomosis in esophageal atresia type I without a gap.This paper reports the case of an infant born with type I esophageal atresia (EA) associated with duodenal atresia (DA). The critical condition of the patient necessitated an exploratory laparotomy, which revealed severe dilatation of the stomach and duodenum. The routine procedure for repairing type I EA is a delayed primary anastomosis after 10 weeks of age because of the long gap between the two esophageal segments. In our case, due to the concomitant DA, the lower pouch was long enough to allow primary neonatal anastomosis. A radiograph taken with a Hegar dilator in the lower segment via the gastrostomy confirmed this suspicion, and the baby underwent a thoracotomy and primary anastomosis between the esophageal pouches. The authors propose the possibility of primary esophageal anastomosis in similar cases.- - - - - - - - - - ranking = 6keywords = atresia (Clic here for more details about this article) |
3/21. Laryngotracheo-esophageal cleft in a neonate with esophageal atresia and tracheo-esophageal fistula: report of a case.Laryngotracheo-esophageal cleft (LTEC) is a congenital anomaly, rarely found in neonates with esophageal atresia (EA) and tracheo-esophageal fistula (TEF), that poses diagnostic and treatment dilemmas for the attending surgeon. In most cases previously reported, the diagnosis of this association was made either at surgery or at autopsy. We present herein the case of a neonate with EA and distal pouch (type C) TEF who was also found to have a LTEC (Evans type III) at the time of surgery. The salient clinical and radiological features of this association are highlighted to increase awareness of the possibility of this rare association and to help promote its early detection.- - - - - - - - - - ranking = 5keywords = atresia (Clic here for more details about this article) |
4/21. Pericardial flap aortopexy: an easy and safe technique in the treatment of tracheomalacia.A 5-month-old boy who had been operated for esophageal atresia and tracheoesophageal fistula was presented with recurrent life-threatening apneic spells, expiratory stridor and difficulty in feeding. diagnosis of tracheomalacia was confirmed by bronchoscopy and pericardial flap aortopexy was performed. Pericardial flap aortopexy is a relatively simple procedure with minimal risk to the aorta. Minimal dissection is required and there are no sutures placed in the aortic wall, thus avoiding the risk of tears.- - - - - - - - - - ranking = 1keywords = atresia (Clic here for more details about this article) |
5/21. The efficacy of laparoscopy in detecting and treating associated congenital malformations in children.One of the main advantages of laparoscopy in children is the fact that it enables a magnified view and the possibility to explore the whole abdominal cavity. This case report clearly shows these advantages. We report the case of a 3-yr-old girl, suffering from severe GERD and right inguinal inguinal hernia, who had already been operated at birth for esophageal atresia. We performed a laparoscopic fundoplication according to Nissen and, at the end of procedure, we decided to turn the optic down to control the right inguinal region to confirm the presence of an inguinal hernia. To our great surprise we found a right oblique external hernia as well as a direct inguinal hernia on the same side. Both hernias was treated successfully in laparoscopy. At a 1-year follow-up, the patient presented no reflux and no recurrence of the inguinal hernias. The laparoscopy in this case permitted operation on two different pathologies involving the upper and lower parts of the abdominal cavity using the same ports and without enlarging the incision, as would happen in laparotomy. The main relevance of this case is that laparoscopy allowed the detection of an associated pathology like a direct inguinal hernia that would have been certainly overlooked in open surgery and could have caused a recurrent hernia if operated via open surgery.- - - - - - - - - - ranking = 1keywords = atresia (Clic here for more details about this article) |
6/21. Bilateral urinary calculi after treatment with a silicate-containing milk thickener.nephrocalcinosis and/or urinary calculi are rare in infants. furosemide treatment during the neonatal period, vitamin d intoxication, hereditary diseases such as hyperoxaluria or distal tubular acidosis are among the most common aetiologies. We report the case of a 6-month-old boy with an extra-hepatic biliary duct atresia treated by the Kasai procedure and a gastro-oesophageal reflux treated with a silicate containing milk thickener (Gelopectose, 5.5% colloidal silicate) since the neonatal period. He did not present any other endogenous risk factor for urinary stone formation (normal urinary calcium/creatinine ratio; normal urinary magnesium excretion). The nephrolithiasis was discovered as the boy presented painful episodes of macroscopic haematuria. Ultrasound examination revealed bilateral nephrocalcinosis and multiple bilateral calculi without infection or urinary obstruction. Infrared spectroscopy revealed silicate as the major component suggesting silicate absorption to be responsible for the described symptoms. After replacement of the silicate-containing agent by a silicate-free milk thickener, the lesions were completely reversible as confirmed by repeated renal ultrasound examinations over a 2-month period. CONCLUSION: Silicate-containing milk thickeners can be responsible for urinary calculi and/or nephrocalcinosis.- - - - - - - - - - ranking = 1keywords = atresia (Clic here for more details about this article) |
7/21. Treacher Collins syndrome with craniosynostosis, choanal atresia, and esophageal regurgitation caused by a novel nonsense mutation in TCOF1.Treacher Collins syndrome (TCS) is caused by mutations in TCOF1 of the nonsense, small deletion, and small insertion types, which most likely result in haploinsufficiency. We report a novel de novo nonsense mutation 2731C --> T, resulting in Arg911Stop, which truncates the protein. Our patient had the classic findings of TCS, but with documented craniosynostosis, choanal atresia, and esophageal regurgitation.- - - - - - - - - - ranking = 5keywords = atresia (Clic here for more details about this article) |
8/21. Congenital esophageal stenosis owing to ectopic tracheobronchial remnants.BACKGROUND/PURPOSE: Congenital esophageal stenosis owing to tracheobronchial remnants (TBR) is a rare condition. Inappropriate treatment often is carried out before the correct diagnosis is established. For a better understanding and management of this disease, patients with TBR treated at our hospital and collected from the literature are reviewed to evaluate the course of onset, associated anomalies, methods of diagnosis and treatment, and outcomes. methods: Three patients treated at our hospital and 59 patients identified from the literature were included in the study. Gender, age at onset of symptoms, age at definitive treatment, esophagographic findings, pathology, methods of treatment, and outcomes of the 62 patients were recorded and analyzed. RESULTS: Boys slightly predominated (33:28, 1 unknown gender). Symptoms of dysphagia and regurgitation developed at the mean age of 3.2 /- 4.5 months. Definitive treatment was carried out at the mean age of 2.6 /- 3.0 years with a time lag of 2.0 /- 2.5 years from the onset of symptoms. Twenty-five patients had associated anomalies with esophageal atresia being the most prevalent. Esophagography showed segmental stenosis over the distal third of the esophagus in all patients except one. The esophagographic findings could be classified into 3 types: type Ia, 10 cases; Ib, 15 cases; type II, 14 cases; type III, 3 cases. A nonyielding esophageal stenosis without inflammation was the characteristic esophagoscopic finding. Esophagoscopic dilatation of the stenosis was attempted in 26 patients, but all failed, and 2 patients suffered esophageal perforation. Surgical resection was mandatory for all patients to restore their esophageal continuity. postoperative complications included anastomotic stenosis, anastomotic leakage, hiatal hernia, and gastroesophageal reflux. CONCLUSIONS: TBR should be suspected in patients who present with a typical history of dysphagia after ingestion of solid food and have characteristic esophagographic and esophagoscopic findings. It has a strong tendency to occur with esophageal atresia. Esophagoscopic dilatation is ineffective and may render the patient at risk for esophageal perforation. Operation is the treatment of choice and carries little morbidity and mortality.- - - - - - - - - - ranking = 2keywords = atresia (Clic here for more details about this article) |
9/21. Very long gap esophageal atresia successfully treated by esophageal lengthening using external traction sutures.esophageal atresia with a 6-cm gap or longer and a very short distal segment represents the extreme of this disorder's spectrum, the treatment of which can be challenging. Very often, several surgical procedures have to be carried out to maintain the patient's own esophagus. The authors report on a child born with isolated esophageal atresia without fistula and a very long gap (8.5 vertebral spaces in length). Delayed anastomosis was accomplished using a combination of various procedures that included a waiting period allowing for spontaneous esophageal growth, mobilization of the distal segment, and esophageal lengthening by external traction sutures. The aim of this report is to define the role of the traction method in the repair of this kind of atresia.- - - - - - - - - - ranking = 7keywords = atresia (Clic here for more details about this article) |
10/21. Reassessment of the end-to-side operation for esophageal atresia with distal tracheoesophageal fistula: 22-year experience with 68 cases.End-to-side anastomosis (ES) and ligation of the tracheoesophageal fistula (TEF) has been the procedure of choice for esophageal atresia at our institution since 1967. This report summarizes our operative and long-term results with the ES operation in 68 babies, including 33 in Waterston group A (50%), 23 in group B (35%), and 12 in group C (15%). An additional 10 patients had a primary end-to-end (EE) anastomosis, while 14 others required either staged EE repair or an esophageal replacement procedure. overall survival rate with ES was 93% including two deaths attributed to major anastomotic leaks and sepsis, and three others in group C from cardiac anomalies. Six (9%) of those having ES anastomosis developed a recurrent TEF between 40 days and 21 months of age, necessitating reoperation. Predisposing factors to recurrent TEF were surgical inexperience (three cases; first operation for each surgeon), forceful vomiting secondary to gastroesophageal reflux (GER) in two, and drug overdose in one. anastomotic leak occurred in seven (10%) following end-to-side repair and was implicated in two deaths. Three patients developed minor anastomotic stricture requiring less than three dilatations, while one with a tight stricture needed as many as five dilatations over the first 14 months of life. Mild dysphagia and respiratory symptoms were uniformly observed during the first year, but only five patients (7%), including the two with recurrent TEF, required fundoplication for persistent GER. All patients were eating table foods after 1 year of age, while 10 (15%) have required periodic endoscopic removal of solid food lodged at the radiographically unobstructed anastomosis.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 5keywords = atresia (Clic here for more details about this article) |
| | Next -> |