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TÜRKÇE
Poster - 19
Management and surgical outcomes in esophageal atresia with proximal fistula (Gross Types B/D): Insights from the Turkish Esophageal Atresia Registry (TEAR)
Ü Çeltik 1, Ç Ulukaya Durakbaşa 2, G Şalcı 3, T Soyer 4, SA Bostancı 5, A Karaman 6, AE Hakalmaz 7, İ Çiftçi 8, A Parlak 9, D Demirel 10, G Göllü 11, B Çığşar Kuzu 12, İ Akkoyun 13, H İlhan 14, ŞS Kılıç 15, O Uzunlu 16, A Süzen 17
1 Ege University Faculty of Medicine Department of Pediatric Surgery
2 Istanbul Medeniyet University Faculty of Medicine Department of Pediatric Surgery
3 Karadeniz Technical University Faculty of Medicine Department of Pediatric Surgery
4 Hacettepe University Faculty of Medicine Department of Pediatric Surgery
5 Ankara Bilkent City Hospital Department of Pediatric Surgery
6 Dr. Sami Ulus Maternity and Children Training and Research Hospital, Department of Pediatric Surgery, Ankara
7 Istanbul University Cerrahpasa Faculty of Medicine Department of Pediatric Surgery
8 Selcuk University Meram Medical Faculty Department of Pediatric Surgery
9 Bursa Uludag University, Faculty of Medicine, Department of Pediatric Surgery
10 Ondokuz Mayis University Faculty of Medicine Department of Pediatric Surgery
11 Ankara University Faculty of Medicine Department of Pediatric Surgery
12 Izmir Katip Çelebi University Faculty of Medicine Department of Pediatric Surgery
13 Konya City Hospital Department of Pediatric Surgery, Konya
14 Eskisehir Osmangazi University Department of Pediatric Surgery
15 Cukurova University Faculty of Medicine Department of Pediatric Surgery
16 Pamukkale University Faculty of Medicine Department of Pediatric Surgery, Denizli
17 Mugla Sitki Kocman University Faculty of Medicine Department of Pediatric Surgery
Aim: Proximal fistula with esophageal atresia (PTEF-EA) is rare and often misdiagnosed, posing significant challenges in management. We aimed to analyze clinical features, diagnostic methods, treatment strategies, and surgical outcomes for PTEF-EA using data from the TEAR.
Methods: PTEF-EA patients in TEAR between 2015-2023 were evaluated in terms of demographics, diagnostic methods, surgical treatment, and complication
Results: Of 998 cases, 3.4% (n=34 M/F:21/13) had PTEF-EA. Median gestational age was 36.5 weeks, and median birth weight was 2390 grams. 13 were Type D and 21 were Type B. Diagnosis was made by bronchoscopy in 20 and by pouchography in 9 patients. In two cases, the fistula was identified intraoperatively. PTEF ligation was performed via thoracotomy in 10 patients, cervical approach in 6, and thoracoscopy in 5. In Type D, ligation was performed via thoracotomy in 12 cases and thoracoscopy in 1. When comparing Type B-D, groups were similar in terms of gestational age (p=0.255) and birth weight (p=0.507). However, primary anastomosis was significantly more common in Type D. Surgical methods are summarized in Table 1. During follow-up, 5 patients died due to various reasons. Among the 23 patients with one-year follow-up data, 2 (8.7%) experienced recurrent PTEF, 11 (47.8%) developed strictures, and 6 (26.1%) had gastroesophageal reflux.
Conclusion: In PTEF cases, variable treatment approaches were performed depending on patient's anomaly and experience of surgeons. The presence of a distal fistula in PTEF increases the likelihood of primary anastomosis. Management of Type B cases can be more challenging compared to Type D.
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Table 1 |
|||
|
Type B |
Type D |
p |
|
|
Patients number |
21 |
13 |
|
|
Median gap length(vertebrae) |
4 (2-7) |
2 (1-2) |
<0.001 |
|
Primary repair |
3 |
12 |
<0.001 |
|
Delayed repair |
3 |
0 |
0.154 |
|
Traction techniques |
7 |
0 |
0.019 |
|
Replacement surgery |
6 |
1 |
0.143 |