Treatment of Poor Risk Patients with Essophageal Atresia Associated with Tracheo-esophageal Fistula

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  • Ito Takahiro
    First Department of Surgery, Nagoya University School of Medicine:Department of Surgery, Central Hospital, Aichi Colony
  • Sugito Tetsuyuki
    First Department of Surgery, Nagoya University School of Medicine:Department of Surgery, Central Hospital, Aichi Colony
  • Nagaya Masahiro
    First Department of Surgery, Nagoya University School of Medicine:Department of Surgery, Central Hospital, Aichi Colony
  • Yamada Noboru
    First Department of Surgery, Nagoya University School of Medicine:Department of Surgery, Central Hospital, Aichi Colony
  • Ishiguro Yukio
    First Department of Surgery, Nagoya University School of Medicine:Department of Surgery, Central Hospital, Aichi Colony

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Other Title
  • Gross C 型食道閉鎖症重症例の治療と予後
  • Gross Cガタ ショクドウ ヘイサショウ ジュウショウレイ ノ チリョウ

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Twenty four patients with esophageal atresia associated with tracheo-esophageal fistula, who were classified as Waterstone C group, were reviewed. Thirteen patients survived after primary esophageal anastomosis with a division of the tracheo-esophageal fistula. This procedure was performed on eight patients shortly after admission, bul only four survived. On the other hand, it was performed on ten patients few days or few weeks after admission and nine survived. None of the patients who hac! undergone only gasirostomy or no operation were alive. Femimonia was successfully treated by respiratory care including tracheal suction, physiotherapy, mechanical ventilation and antibiotics, in spite of the presence of tracheo-esophageal fistula in must of patients within two weeks after admission. Adequate nutritional support was provided by a transpyloric or jejunostomy tube until delayed primary anastomosis was performed. Duodenal obstruction and imperforate anus were treated before primary anastomosis was performed. A patient with progressive congenstive heart failure due ro aor to -pulmonary septal defect was treated surgically before esophageal operation. Most of other cardiovascular anomalies did not require any surgical treatment before delayed primary anastomosis. A premature less than 1,500 gm without any severe anomalies and complication survived afler delayed primary anastomosis. In conclusion, delayed primary anastomosis can be superior to staged procedures tor poor risk patients today when proper respiratory care and nutritional management are available in most pediatric surgical centers.

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