Seasonal Frequency in Esophageal Atresia/Tracheo-Esophageal Fistula: Is there an Environmental Etiology?

Background: Esophageal Atresia and Tracheo-Esophageal Fistula (EA/TEF) occurs sporadically and its eti-ology is poorly understood. We observed six cases of EA/TEF within three weeks of October 2007 at the Lagos University Teaching Hospital (LUTH), Nigeria. Aims: To analyze the monthly trends of presentation of EA/TEF at the LUTH from 2002-7, test the hypothesis that the October figures were not due to chance and correlate data with known local disease patterns. Setting: Lagos University Teaching Hospital, Nigeria. Patients, Materials, Method: A retrospective analysis of all EA/TEFs managed at the LUTH within stated period. Results: 25 babies with EA/TEF presented over the period. 10 (40%) were seen in the month of Oc-tober, 5 (20%) occurred in May while the rest were spread over the rest of the months. Chi-square analysis confirmed that the EA/TEF cases occurred significantly more frequently in October (P < 0.001) and this ob-servation was unlikely due to chance. Conclusions: There seems to be a seasonal variation in the occurrence of EA/TEF in Lagos, with a significantly higher frequency in the month of October. 96% of mothers of ba-bies with EA/TEF lived in low socioeconomic parts of Lagos. This study highlights the possibility of local viral etiology of EA/TEF.

Role of preoperative tracheobronchoscopy in newborns with esophageal atresia:A review

Preoperative tracheobronchoscopy(TBS) in the diag-nostic assessment of newborns affected by esophageal atresia(EA) was described in 1981. Nevertheless, the value of the procedure is actually much debated; only a few studies have clearly explored the advantages of TBS and this procedure is not yet routinely included inthe diagnostic and therapeutic assessment in many in-ternational pediatric surgery settings. Routine preoper-ative TBS is a safe procedure that enables the accurate examination of the tracheobronchial tree, the visualiza-tion of tracheoesophageal fistula and the diagnosis of tracheomalacia or associated respiratory anomalies. When a distal fistula is found, its occlusion with a Fog-arty balloon catheter improves mechanical ventilation and facilitates surgical repair. This review provides a detailed overview on the use of TBS in newborns with EA, focusing on technical aspects, anesthesiological management, indications and limits. The benefits and risks of the procedure are also compared with alterna-tive diagnostic tools, such as an esophageal contrast study, computed tomography scan and ultrasound.

Small bowel intussusception in a child following feeding jejunostomy: A rare case with review of literature

Jejuno-jejunal intussusception is a rare complication of feeding jejunostomy tube placement. A case of one year old child who underwent gastric pull-up for complicated tracheo-esophageal fistula had jejuno-jejunal intussusception induced by Witzel's feeding jejunostomy tube;is discussed with review of literature.

Is routine use of transanastomotic tube justified in the repair of esophageal atresia?

Background:Transanastomotic feeding tube (TAFT) is commonly used for post-operative enteral nutrition after esophageal atresia (EA)/tracheoesophageal fistula (TEF) repairs.The purpose of this study is to analyze the therapeutic implications of avoiding a TAFT and its impact on the outcomes post-operatively.Methods:The medical data of 33 inpatients with EA/TEF type C repair from 2009 to 2014 were retrospectively reviewed.Patients were divided into two groups for comparison based on the usage of TAFT during the repair:TAFT-(without) and TAFT+ (with) groups,without randomization.Both groups were compared statistically for post-operative complications and outcomes.Results:Eighteen neonates were males and 15 females,with an average birth weight of 2.43±0.43 kg and a mean gestational age of 36.15 weeks.Nineteen (57.5%) in the TAFT-group and 14 (42A%) were in the TAFF+ group.The post-operative complications,need for dilatations,duration of total parenteral nutrition (TPN) and length of hospital stay were similar in both groups.The incidence of pneumonitis was significantly higher in the TAFT+ group.Conclusions:By avoiding a TAFT,there is no increase in complication rates nor does it entail a prolonged period of TPN.Besides,not using a TAFT may have the advantage of reducing incidence of aspiration and consequent pneumonifis.