Abstract
Proximal fistulae occur only infrequently in esophageal atresia. Type B atresia is seen in 0%–3% and type D atresia in 0.25%–7.7%. In the past 16 years 149 children with esophageal atresia have been treated in the Department of Pediatric Surgery of the University Hospital in Nijmegen. Only 2% and 4% had type B and type D esophageal atresia respectively. There were no routine preoperative contrast studies in this series. There was only a slight increase in morbidity in these patients due to a delay in diagnosing the proximal fistula. Routine preoperative contrast studies are not only time-consuming, but also do not guarantee visualization of the fistula, and the risk of contrast pneumonia always remains. Weighing the pros and cons of these observations, we think it unnecessary to perform extensive routine preoperative contrast studies in all patients with esophageal atresia. Contrast studies should be performed on clinical suspicion of a proximal fistula and should always be performed in close co-operation with an experienced pediatric radiologist. The proximal fistula can best be closed via a cervical incision.
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References
Haight C, Towsley HA (1943) Congenital atresia of the esophagus with tracheoesophageal fistula. Extrapleural ligation of fistula and end-to-end anastomosis of esophageal segments. Surg Gynecol Obstet 76: 672–675
Koop CE (1971) Recent advances in the surgery of esophageal atresia. Prog Pediatr Surg 2: 41–56
Johnson AM, Rodgers BM, Alford B, Minor GR, Shaw A (1984) Esophageal atresia with double fistula: the missed anomaly. Ann Thorac Surg 38: 195–200
Howard R, Meyers NA (1965) Esophageal atresia: a technique for elongating the upper pouch. Surgery 58: 725–727
Hays DM, Woolley M, Snyder WH (1966) Esophageal atresia and tracheoesophageal fistula: management of the uncommon types. J Pediatr Surg 1: 240–252
Cumming WA (1975) Esophageal atresia and tracheoesophageal fistula. Radiol Clin North Am 13: 277–295
de Lorimer AA, Harrison MR (1985) Esophageal atresia: embryogenesis and management. World J Surg 9: 250–257
Dudgeon DL, Morrison CW, Woolley MM (1972) Congenital tracimal tracheoesophageal fistula. J Pediatr Surg 7: 614–619
Louhimo I, Lindahl H (1983) Esophageal atresia: primary results of 500 consecutively treated patients. J Pediatr Surg 18: 217–229
Myers NA, Aberdeen E (1979) In: Ravitch MM, Welch KJ, Benson CD, Aberdeen E, Randolph JG (eds) Pediatric surgery. Year Book, Chicago, London, pp 446–469
Rerdon WE, Baker DH (1975) Radiographic findings in esophageal atresia with proximal pouch fistula (type B). Pediatr Radiol 3: 70–74
Raffensperger JG (ed) (1980) Swenson's pediatric surgery, 4th edn. Appleton Century Crofts, New York, pp 455
Ein SH, Stringer DA, Stephens CA, Shardling B, Simpson J, Filler RM (1983) Recurrent TEFs: a seventeen-ye ar review. J Pediatr Surg 18: 436–441
Filston HC, Rankin JS, Grimm RN (1984) Esophageal atresia. Prognostic factors and contribution of preoperative telescopic endoscopy. Ann Surg 199: 532–537
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van der Zee, D.C., van der Staak, F.H.J., Severijnen, R.S.V.M. et al. Proximal fistula in esophageal atresia: pitfall in a routine procedure. Pediatr Surg Int 3, 23–26 (1988). https://doi.org/10.1007/BF00177075
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DOI: https://doi.org/10.1007/BF00177075