• Advances in pediatric surgery
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• v.1 no.1
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• pp.63-67
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• 1995

Although bleeding was reported before as the first symptom in a few cases of biliary atresia, this association is not generally known. We treated 115-day-old female with extrahepatic biliary atresia presented with subdural hemorrhage rather than with prolonged jaundice. Four years after craniectomy and Kasai's hepatic portojejunostomy, she looks happy without jaundice nor brain damage sequela even though she had recent episode of esophageal variceal bleeding.

• Neonatal Medicine
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• v.25 no.4
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• pp.186-190
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• 2018

Esophageal atresia (EA) with proximal tracheoesophageal fistula (TEF; gross type B) is a rare defect. Although most patients have long-gap EA, there are still no established surgical guidelines. A premature male infant with symmetric intrauterine growth retardation (birth weight, 1,616 g) was born at 35 weeks and 5 days of gestation. The initial diagnosis was pure EA (gross type A) based on failure to pass an orogastric tube and the absence of stomach gas. A "feed and grow" approach was implemented, with gastrostomy performed on postnatal day 2. A fistula was detected during bronchoscopy for recurrent pneumonia; thus, we confirmed type B EA and performed TEF excision and cervical end esophagostomy. As the infant's stomach volume was insufficient for bolus feeding after reaching a body weight of 2.5 kg, continuous tube feeding was provided through a gastrojejunal tube. On the basis of these findings, esophageal reconstruction with gastric pull-up was performed on postnatal day 141 (infant weight, 4.7 kg), and he was discharged 21 days postoperatively. At 12 months after birth, there was no catch-up growth; however, he is currently receiving a baby food diet without any complications. In patients with EA, bronchoscopy is useful for confirming TEF, whereas for those with long-gap EA with a small stomach volume, esophageal reconstruction with gastric pull-up after continuous feeding through a gastrojejunal tube is worth considering.

• Advances in pediatric surgery
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• v.12 no.2
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• pp.175-182
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• 2006

VATER association is defined as a combination of 3 or more anomalies- vertebra (V), imperforate anus (A), esophageal atresia with or without tracheoesophageal fistula (TE), renal and radial anomaly(R). We reviewed our experiences in one center to determine etiology, prevalence, clinical manifestation, other associated anomaly and prognosis. Two hundred and twenty-three cases that underwent operations for imperforate anus or esophageal atresia were analyzed retrospectively through medical records at Department of Pediatric Surgery, Asan Medical Center from June, 1989 to July, 2005. The total number of neonates who had been admitted during period of study were 46,773 and VATER association was 9 (0.019 %, 1.92 persons per 10,000 neonates). Median gestational age and birth weight were $37^{+4}wk$ ($35^{+1}$ - $41^{+4}$) and 2,594 g (1,671-3,660), respectively and median age of mother was 32 years (23-38). There was no family history. Three patients were twins but their counterparts had no anomalies. Patients who have 3 anomalies were 6, 4 anomalies in two and 5 anomalies in one patient. Vertebra anomalies were detected in 7(77.7 %), imperforate anus in 8(88.9 %), esophageal atresia in 5 patients (55.6 %), renal anomaly in 6(66.7 %), and radial anomaly in 5(55.6 %), respectively. Four patients are alive, 2 patients were lost during follow up period. Three patients died due to neonatal sepsis, respiratory dysfunction and cardiac failure. VATER association did not appear to be a definite risk factor, but merely a randomized combination of 5 anomalies. The prognosis was dependent on the other associated anomalies, appropriateness of management and operation. Careful follow-up and aggressive treatmentare required for improving survival and quality of life.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.12 no.1
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• pp.6-10
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• 2016

Esophageal atresia is the abnormal development of the esophagus that connects the mouth to the stomach. This birth defect results in the incomplete connection of the esophagus to the stomach causing an inability to swallow properly and breathing difficulties. Surgery is the only treatment for esophageal atresia. Patients undergone an esophageal reconstruction usually suffer from gastroesophageal reflex. A 5-year old boy with congenital esophageal atresia and Sciwitar syndrome visited Seoul National University Dental Hospital because generalized excessive loss of tooth structure. The patient had history of multiple operations for reconstruct esophagus. He had little food intake experience thought oral and had difficulty to swallowing. The patient was generalized severe erosive and decayed state. For patient, the dental procedure under general anesthesia was scheduled due to the multiple caries with erosion and poor cooperation. Under general anesthesia, pulpectomy and restoration as well as extraction was performed. Gastroesophageal reflex is potentially serious condition, with various extraesophageal adverse effects such as dental erosion. To prevent progression of dental caries, dietary counselling and oral hygiene instruction should be reinforced. Also, restorations to erosive teeth will maintain esthetics and function and preserve pulp vitality.

• Advances in pediatric surgery
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• v.14 no.1
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• pp.1-11
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• 2008

The aim of this study is to analyze the outcomes of the esophageal atresia with tracheoesophageal fistula over the last 2 decades. The records of 51 patients born between 1987 and 2006 were reviewed. Twenty-seven patients were male. Mean values of the age, gestational age and birth weight were 2.9 days, 296 days and 2.7kg, respectively. All patients had Gross type C anomalies. Thirty-one patients (60.7 %) had one or more associated congenital anomalies and the most common anomaly was cardiac malformation. In 48 cases, primary anastomosis was done and staged operation was done in one case. Circular myotomies in the proximal esophagus were performed in 9 cases. Postoperative complication developed in 26 cases (54 %): pulmonary complication in 12 cases, anastomotic leakage in 10 and anastomotic stricture in 10, recurrent trachoesophageal fistula in one and tracheomalasia in 2 cases. Reoperation was carried out in 2 patients with anastomotic leaks, the remaining leaks were managed non operatively. Three of the strictures were reoperated upon and the others were successfully managed by balloon dilatations. Overall mortality rate was 15.6 %. Mortality rate of the second 10 years (8 %) period decreased significantly compared to that of the first 10 years (23 %) period.

• Advances in pediatric surgery
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• v.14 no.1
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• pp.12-20
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• 2008

From 1979 to 2006, fifty eight patients with esophageal atresia were treated by one pediatric surgeon at Hanyang University Hospital. We analyzed the clinical findings and outcome of these 58 patients. There were 30 males and 28 females. Their mean birth weight was $2,960{\pm}400g$ (1,170~4,020 g). The most common type of anomaly was Gross type C (49 patients; 84.5 %). There was no type B. Fifty-two patients underwent definitive surgery. Postoperative complications were as follows: anastomotic leakage in 17 patients (32.7 %), anastomotic site stricture in 15 (28.8 %), gastroesophageal reflux in 10 (19.2 %) and recurrent TEF in 1 (1.9 %). A total of 152 associated anomalies were detected from 48 patients (82.2 %). The cardiovascular system was the most commonly affected (30 patients with 46 anomalies). The VACTERL association was present in 14 patients (24.1 %). Operative mortality was 17.3 % including self-discharge patients after operation.

• Journal of Chest Surgery
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• v.41 no.5
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• pp.671-674
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• 2008

Jejunum and fasciocutaneous and myocutaneous flaps are theoretically recommended as esophageal substitutes in reconstruction of the esophagus after several occurrences of failed reconstruction. However, other esophageal substitutes should also be considered. Secondary esophageal reconstruction was successfully performed on a 24-year-old woman who had a history of cervical, thoracic, and abdominal operations and esophageal stricture secondary to several failed reconstructions for esophageal atresia and tracheo-esophageal fistula 21 years prior. The esophageal reconstruction was done subcutaneously by end-to-side anastomosis at the left cervical area using a deformed stomach graft. The patient was discharged with the ability to consume a regular diet after the operation.

• Journal of Chest Surgery
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• v.23 no.2
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• pp.396-401
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• 1990

This report is an review of 5 cases of congenital esophageal atresia associated with tracheoesophageal fistula which were treated in the Department of Thoracic and Cardiovascular Surgery, Chonnam University Hospital from January, 1987 to February, 1989. First patient that was associated with VATER’s syndrome and moderate pneumonia, i.e., Waterston Category C was treated by gastrostomy, colostomy and primary anastomosis, but expired. Second patient that was weighed 2.2 Kg, suffered from moderate pneumonia was treated by gastrostomy, but died from asphyxia. The other patients were treated by primary repair. Any anastomotic leakage or gastroesophageal reflux was not found in these cases, but mild anastomotic strictures were found in these patients by postoperative esophagography. However, esophageal dilatation of anastomotic strictures was successful using the Griintzig balloon catheter.

• Advances in pediatric surgery
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• v.2 no.1
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• pp.68-71
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• 1996

Esophageal atresia(EA) with a double tracheoesophageal fistula(TEF) is rare. It accounts for only 0.7% of all cases of EA and TEF. A male newborn weighing 2860g was born by normal vaginal delivery at 41 weeks' gestation to a 27-year-old mother who had a normal pregnancy. But immediately developed recurrent choking and respiratory distress. Feeding tube was inserted and chest X ray showed the feeding tube coiled in the proximal pouch(T-2 level). With a preoperative diagnosis of EA and distal TEF, the thoracotomy was performed on the third day of life. At thoracotomy, TEF was proved to be a double fistula. Both fistulas were divided and an esophageal anastomosis was performed. The postoperative course was uncomplicated until the eighth postoperative day when a minor anastomotic leak. The patient was discharged at 103 days of age.

• Advances in pediatric surgery
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• v.1 no.2
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• pp.140-148
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• 1995

To study the clinical profiles and outcome of surgery in infants with esophageal atresia, we reviewed 96 esophageal atresia cases who were treated from April, 1978 to June, 1995. There were 51 male and 45 female infants, a ratio of 1.1:1. The low birth weight(<2500g) patients were 32%. Clinical findings at the time of diagnosis included drooling in 57%, choking in 50%, cyanosis in 38%, respiratory distress in 27% and swallowing difficulty in 20%. Gross classification included 6 cases of type A esophageal atresia(6%), 79 cases of type C(82%), 3 cases of type E (3%) and 8 cases of type F(8%). Associated anomalies occurred in 34 infants(35%). Among them, cardiac anomalies were most common(60%). A primary repair of the defect was carried out in 76 patients with type A or C. A staged operation comprising a repair or gastric tube interposition after gastrostomy was performed in 8 patients. In all 3 infants with H-type, a division of fistula was performed. Esophageal resection and anastomosis was done in 8 infants with esophageal stenosis. In one infant, a gastrostomy was performed and he expired before staged operation. Anastomotic complications included leakage in 16 cases(17%), stricture in 37 cases(39%) and recurrent tracheoesopohageal fistula in 3 cases(3%). The mortality rate was 14% and the leading cause of death was pneumonia. The overall survival rate was 86%, and according to Waterston criteria, the survival rates were 93%, 85% and 58% in class A, Band C, respectively. 75 patients were followed up with median follow up 6.4 years. Among them, 93% were uneventful and 7% had frequent pneumonia.