[Current Treatment of Esophageal Atresia with Tracheoesophageal Fistula - Updated Guidelines of the German Society of Pediatric Surgery].

Abstract

Esophageal atresia (EA) is a congenital anomaly that entails an interrupted esophagus with or without tracheoesophageal fistula (TEF). Depending on the distance of the two esophageal pouches a "short-gap" is distinguished from a "long-gap" variant. Up to 50% of newborns have additional anomalies. EA is prenatally diagnosed in 32-63% of cases. Recently, the interdisciplinary care in these children underwent substantial changes. Therefore, we summarize the current guideline of the German society of pediatric surgery for the treatment of patients with EA and distal TEF (Gross Type C). Controversies regarding the perioperative management include surgical-technical aspects, such as the thoracoscopic approach to EA, as well as general anesthesia (preoperative tracheobronchoscopy, intraoperative hypercapnia and acidosis). Moreover, postoperative complications and their management like anastomotic stricture are outlined. Despite significant improvements in the treatment of EA, there is still a relevant amount of long-term morbidity after surgical correction. This includes dysmotility of the esophagus, gastroesophageal reflux disease, recurrent respiratory infections, tracheomalacia, failure to thrive, and orthopedic complications following thoracotomy in the neonatal age. Therefore, close follow-up is mandatory to attain optimal quality of life.

• Authors: Steffi Mayer, Heidrun Gitter, Peter Göbel, Franz Wolfgang Hirsch, Claudia Höhne, Stuart Hosie, Jochen Hubertus, Andreas Leutner, Oliver Muensterer, Peter Schmittenbecher, Elias Seidl, Holger Stepan, Ulrich Thome, Holger Till, Anke Widenmann-Grolig, Martin Lacher
• Journal: Klinische Padiatrie (Klin Padiatr) Vol. 232 Issue 4 Pg. 178-186 (Jul 2020) ISSN: 1439-3824 [Electronic] Germany
• Vernacular Title: Behandlung der Ösophagusatresie mit unterer tracheoösophagealer Fistel – Zusammenfassung der aktuellen S2K-Leitlinie der DGKCH.
• PMID: 32590849 (Publication Type: Journal Article)
• Copyright: © Georg Thieme Verlag KG Stuttgart · New York.

Topics

• Child
• Esophageal Atresia (surgery)
• Humans
• Infant, Newborn
• Pediatrics
• Practice Guidelines as Topic
• Quality of Life
• Tracheoesophageal Fistula (surgery)
• Treatment Outcome