Original article
Preoperative tracheobronchoscopy in newborns with esophageal atresia: does it matter?

https://doi.org/10.1016/j.jpedsurg.2006.01.074Get rights and content

Abstract

Background/Purpose

Despite surgical refinements, perioperative use of tracheobronchoscopy (TBS) as part of surgical approach to esophageal atresia (EA) is still controversial. The purpose of this study was to evaluate the influence of preoperative TBS in newborns with EA in preventing complications and improving diagnosis and surgical treatment.

Methods

In the period ranging from 1997 to 2003, 62 patients with EA underwent preoperative TBS. The procedure was carried out with flexible bronchoscope maintaining spontaneous breathing. When a wide carinal fistula was found, this was mechanically occluded by Fogarty catheter and cannulated with rigid bronchoscopy. Type of EA, surgical procedure variations caused by TBS, and associated anomalies not easily detectable were recorded.

Results

Before TBS, the Gross classification of the 62 patients was as follows: type A, 9 patients; type B, none; type C, 51 patients. At TBS, however, 3 of 9 type A patients had an unsuspected proximal fistula (type B). These 3 patients, plus the 2 with H-type fistula, were repaired through a cervical approach. In 4 patients, previously undetected malformations of the respiratory tree (2 aberrant right upper bronchus and 2 hypoplastic bronchi) were found at TBS. Carinal fistulas in 14 type C patients were occluded by Fogarty catheter to improve ventilation during repair. No complications were observed. Overall, TBS was clinically useful in 28 (45.2%) of 62 patients, including 15 (24.2%) of 62 infants in whom it was crucial in modifying the surgical approach.

Conclusion

Tracheobronchoscopy is a useful and safe procedure and should be recommended in tertiary centers for babies with EA before surgical repair.

Section snippets

Materials and methods

The records of patients with EA undergoing TBS in the period ranging from 1997 to 2003 were retrospectively reviewed. Parameters recorded were the following: pre-TBS classification of EA and post-TBS classification (Gross classification) [7], birth weight, gestational age, associated anomalies, and surgical procedure variations depending on TBS result were also taken into account. A modified approach, depending on TBS, was defined as follows: (1) TBS changing the previously planned surgical

Results

Sixty-two patients (35 males, 27 females) fulfilled the aforementioned criteria and formed the object of the study.

Patients' birth weight was 2.606 ± 664 g (range, 1.340-4.590 g) and gestational age was 37.5 ± 3 weeks (range, 31-42 weeks). Associated anomalies were present in 41 patients.

Before TBS, diagnosis of anatomic type EA was as follows: type C, 51 (82.2%) patients; type A, 9 (14.6%) patients; type E, 2 (3.2%) patients. After TBS, anatomic classification was changed into the following:

Discussion

In 1981, Benjamin [1] described the first experience of TBS in newborns with EA. In these babies, TBS allows to exactly assess the type of EA: the presence, the number, and the location of the fistula are also fine-tuned [2], [4], [6].

Filston et al [9], in 1982, first described the technique of endoscopic insertion of a Fogarty balloon catheter for temporary occlusion of TEF to facilitate positive-pressure ventilation of noncompliant premature lungs before surgical closure of fistula.

Since

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Presented at the LI Annual Congress of the British Association of Paediatric Surgeons, Oxford, England, July 27, 2004.

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