Abstract
A method to achieve distal fistula occlusion by inflating the balloon of a catheter placed at the gastroesophageal junction via a transgastric route was tried in seven consecutive neonates with esophageal atresia and wide distal fistula. Due to associated moderate or severe pneumonia, these infants were at poor anesthetic risk for the definitive repair. The procedure was done under local anesthesia with mild sedation and took an average of half an hour for completion. Another feeding tube was negotiated through another gastrotomy across the pylorus to allow early enteral feeds. Temporary transgastric fistula occlusion (TTFO) allowed better ventilation of the hypocompliant lungs (by increasing resistance at the fistulous end), prevented lung injury due to aspiration of the refluxing gastric juices, and facilitated optimal ventilation by preventing epigastric distension. All study subjects survived this procedure except for one of our earlier study subjects who died of massive pneumothorax that was a procedure-related complication. None of the remaining subjects required mechanical ventilation either after TTFO or after the definitive esophageal repair that was carried out 5–7 days subsequent to TTFO, except for one other neonate with right lung aplasia who began deteriorating 48 h after thoracotomy and died of cardiac failure. There were no anastomosis-related problems among the survivors over a 12-month follow-up. The gratifying results of our study prompt us to suggest that this procedure deserves attention, and its role should be explored for salvaging neonates with type C esophageal atresia with wide fistula and pneumonia in developing countries with few neonatal intensive care services.
Similar content being viewed by others
References
Waterston DJ, Carter RE , Aberdeen E (1962) Oesophageal atresia: tracheo-oesophageal fistula. A study of survival in 218 infants. Lancet 1:819–822
Poenaru D, Laberge JM, Neilson IR et al (1993) A new prognostic classification for esophageal atresia. Surgery 113:426–432
Calverley RK, Johnston AE (1972) The anaesthetic management of tracheo-esophageal fistula: a review of ten years’ experience. Can Anaesth Soc J 19:270–282
Filston HC, Chitwood WR, Schkolne B, Blackmon LR (1982) The Fogarty balloon catheter as an aid to management of the infant with esophageal atresia and tracheo-esophageal fistula complicated by severe RDS or pneumonia. J Pediatr Surg 17:149–151
Randolph JG, Tunell WP, Lilly JR (1968) Gastric division in the critically ill infant with esophageal atresia and tracheo-esophageal fistula. Surgery 62:496
Harmon CM, Coran AG (1998) Congenital anomalies of the esophagus. In: O’Neill JA, Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran AG (eds) Pediatric surgery. Mosby, London, pp 941–967
Salem MR, Wong AY, Lin YH, Firor HV, Benett EJ (1973) Prevention of gastric distention during anesthesia for newborns with tracheoesophageal fistulas. Anesthesiology 38:82–83
Leininger BJ (1972) Silastic banding of esophagus with subsequent repair of esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 7:404–407
Kadowaki H, Nakahira M, Umeda K, Yamada C, Takeuchi S, Tamate S (1982) A method of delayed esophageal anastomosis for high-risk congenital esophageal atresia with additional intraabdominal anomalies; transgastric balloon “fistulectomy”. J Pediatr Surg 17:230–233
Hofman S (1976) Emergency repair of esophageal atresia with lower fistula and segment elongation in cases with a large gap between segments. J Pediatr Surg 11:257–259
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ratan, S.K., Rattan, K.N., Ratan, J. et al. Temporary transgastric fistula occlusion as salvage procedure in neonates with esophageal atresia with wide distal fistula and moderate to severe pneumonia. Ped Surgery Int 21, 527–531 (2005). https://doi.org/10.1007/s00383-005-1407-8
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-005-1407-8