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Refractory tracheoesophageal fistula treated using multi-stage surgery: A case report

A tracheoesophageal fistula (TEF) recurs in approximately 2%–13% of cases of esophageal atresia with TEF that are treated surgically. Currently, there is no consensus on the most effective treatment to prevent recurrent TEF (RTEF). Herein, we present a patient with type C esophageal atresia who unde...

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Autores principales: Nakagawa, Yoichi, Makita, Satoshi, Uchida, Hiroo, Hinoki, Akinari, Shirota, Chiyoe, Sumida, Wataru, Amano, Hizuru, Okamoto, Masamune, Takimoto, Aitaro, Ogata, Seiya, Takada, Shunya, Kato, Daiki, Gohda, Yousuke, Guo, Yaohui
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9811173/
https://www.ncbi.nlm.nih.gov/pubmed/36619516
http://dx.doi.org/10.3389/fped.2022.1053154
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author Nakagawa, Yoichi
Makita, Satoshi
Uchida, Hiroo
Hinoki, Akinari
Shirota, Chiyoe
Sumida, Wataru
Amano, Hizuru
Okamoto, Masamune
Takimoto, Aitaro
Ogata, Seiya
Takada, Shunya
Kato, Daiki
Gohda, Yousuke
Guo, Yaohui
author_facet Nakagawa, Yoichi
Makita, Satoshi
Uchida, Hiroo
Hinoki, Akinari
Shirota, Chiyoe
Sumida, Wataru
Amano, Hizuru
Okamoto, Masamune
Takimoto, Aitaro
Ogata, Seiya
Takada, Shunya
Kato, Daiki
Gohda, Yousuke
Guo, Yaohui
author_sort Nakagawa, Yoichi
collection PubMed
description A tracheoesophageal fistula (TEF) recurs in approximately 2%–13% of cases of esophageal atresia with TEF that are treated surgically. Currently, there is no consensus on the most effective treatment to prevent recurrent TEF (RTEF). Herein, we present a patient with type C esophageal atresia who underwent thoracoscopic esophago-esophageal anastomosis and TEF repair at 2 days old. However, RTEFs were observed at ages 3, 6, and 11 months, and thoracoscopic TEF repairs using a pleural patch, fascia lata graft, and pectoralis major myocutaneous (PMMC) flap were performed, respectively. A fourth recurrence led to mediastinitis, shock liver, disseminated intravascular coagulopathy, and a compromised respiratory status. Hence, laparoscopic esophageal transection was first performed to improve the respiratory condition by preventing the regurgitation of gastric contents. Once the patient was stable, a subtotal esophageal resection with TEF closure followed by gastric tube reconstruction was performed. In conclusion, we encountered a case of refractory RTEF that was repaired four times using various techniques, including a fascia lata graft and PMMC flap. However, TEF still recurred after these four operations. The final surgical strategy involved an esophageal transection as a palliative therapy, which improved the respiratory condition, followed by closure of the TEF and subtotal esophageal resection. Finally, esophageal reconstruction using a gastric tube after the complete remission of inflammation was effective. This multi-stage surgery was considered the only choice to rescue the patient and effectively prevent another recurrence.
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spelling pubmed-98111732023-01-05 Refractory tracheoesophageal fistula treated using multi-stage surgery: A case report Nakagawa, Yoichi Makita, Satoshi Uchida, Hiroo Hinoki, Akinari Shirota, Chiyoe Sumida, Wataru Amano, Hizuru Okamoto, Masamune Takimoto, Aitaro Ogata, Seiya Takada, Shunya Kato, Daiki Gohda, Yousuke Guo, Yaohui Front Pediatr Pediatrics A tracheoesophageal fistula (TEF) recurs in approximately 2%–13% of cases of esophageal atresia with TEF that are treated surgically. Currently, there is no consensus on the most effective treatment to prevent recurrent TEF (RTEF). Herein, we present a patient with type C esophageal atresia who underwent thoracoscopic esophago-esophageal anastomosis and TEF repair at 2 days old. However, RTEFs were observed at ages 3, 6, and 11 months, and thoracoscopic TEF repairs using a pleural patch, fascia lata graft, and pectoralis major myocutaneous (PMMC) flap were performed, respectively. A fourth recurrence led to mediastinitis, shock liver, disseminated intravascular coagulopathy, and a compromised respiratory status. Hence, laparoscopic esophageal transection was first performed to improve the respiratory condition by preventing the regurgitation of gastric contents. Once the patient was stable, a subtotal esophageal resection with TEF closure followed by gastric tube reconstruction was performed. In conclusion, we encountered a case of refractory RTEF that was repaired four times using various techniques, including a fascia lata graft and PMMC flap. However, TEF still recurred after these four operations. The final surgical strategy involved an esophageal transection as a palliative therapy, which improved the respiratory condition, followed by closure of the TEF and subtotal esophageal resection. Finally, esophageal reconstruction using a gastric tube after the complete remission of inflammation was effective. This multi-stage surgery was considered the only choice to rescue the patient and effectively prevent another recurrence. Frontiers Media S.A. 2022-12-21 /pmc/articles/PMC9811173/ /pubmed/36619516 http://dx.doi.org/10.3389/fped.2022.1053154 Text en © 2022 Nakagawa, Makita, Uchida, Hinoki, Shirota, Sumida, Amano, Okamoto, Takimoto, Ogata, Takada, Kato, Gohda and Guo. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Nakagawa, Yoichi
Makita, Satoshi
Uchida, Hiroo
Hinoki, Akinari
Shirota, Chiyoe
Sumida, Wataru
Amano, Hizuru
Okamoto, Masamune
Takimoto, Aitaro
Ogata, Seiya
Takada, Shunya
Kato, Daiki
Gohda, Yousuke
Guo, Yaohui
Refractory tracheoesophageal fistula treated using multi-stage surgery: A case report
title Refractory tracheoesophageal fistula treated using multi-stage surgery: A case report
title_full Refractory tracheoesophageal fistula treated using multi-stage surgery: A case report
title_fullStr Refractory tracheoesophageal fistula treated using multi-stage surgery: A case report
title_full_unstemmed Refractory tracheoesophageal fistula treated using multi-stage surgery: A case report
title_short Refractory tracheoesophageal fistula treated using multi-stage surgery: A case report
title_sort refractory tracheoesophageal fistula treated using multi-stage surgery: a case report
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9811173/
https://www.ncbi.nlm.nih.gov/pubmed/36619516
http://dx.doi.org/10.3389/fped.2022.1053154
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