Escolar Documentos
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Charles Wulf
Tufts Medical Student
Objectives
Overview of Esophageal Atresia
Current Treatments
What is Long Gap Atresia and how its repair
difers
Esophageal Atresia
Epidemiology
Etiology:
No specific etiology
Embryology
Presentation
Very difficult to diagnose prenatally
Prognosis
Most important
predictors:
Birth weight
Severity of
pulmonary
dysfunction
Presence of
major
congenital
cardiac
disease
Survival
Rate
97%
II
59%
III
22%
Management
Before treatment, stabilize: Ventilate,
Treatment Methods
Once patient is stable:
possible.
Extension
Anastomosis
Foker Process:
Background
MCA Repair
Current methods:
The outer rim heals, uniting the pouches and creating an end to
end anastmosis
2nd Magnets placed using guide wires into each pouch, and
checked for magnetic tension
Lovvorn, Harold N., Christopher M. Baron, Melissa E. Danko, Nathan M. Novotny, Brian T. Bucher, Krystal K. Johnston, and Mario F. Zaritzky. "Staged Repair of
Esophageal Atresia: Pouch Approximation And catheter-based Magnetic Anastomosis." Journal of Pediatric Surgery Case Reports (2014): n. pag. Web.
Outcomes
Sutureless anastomosis
Allows for anastomosis using only esophageal
tissue, versus transplant of gastric or other GI
tract tissue
Limitations and
Complications
Limitations
Complications
No reports of failures
Current Evidence
Summary
Esophageal Atresia is a life threatening congenital
condition if not identified or repaired
Sources
Gonzales, Kelly D., and Hanmin Lee."Chapter 35. Congenital Disorders of the Trachea &
Esophagus."CURRENT Diagnosis & Treatment in OtolaryngologyHead & Neck Surgery, 3e.Ed. Anil K.
Lalwani.New York, NY: McGraw-Hill, 2012. n. pag.AccessMedicine.Web.22 Feb. 2015.
Stringer, Mark D., Kathleen M. Mckenna, Ruth B. Goldstein, Roy A. Filly, N.scott Adzick, and Michael R.
Harrison. "Prenatal Diagnosis of Esophageal Atresia."Journal of Pediatric Surgery30.9 (1995): 1258-263.
Web.
Zaritzky, Mario, Ricardo Ben, Gaston I. Zylberg, and Brian Yampolsky. "Magnetic Compression Anastomosis
as a Nonsurgical Treatment for Esophageal Atresia."Pediatric Radiology39.9 (2009): 945-49. Web.
Lovvorn, Harold N., Christopher M. Baron, Melissa E. Danko, Nathan M. Novotny, Brian T. Bucher, Krystal K.
Johnston, and Mario F. Zaritzky. "Staged Repair of Esophageal Atresia: Pouch Approximation Andcatheterbased Magnetic Anastomosis."Journal of Pediatric Surgery Case Reports(2014): n. pag. Web.
Takamizawa, Shigeru, Eigoro Yamanouchi, Toshihiro Muraji, Eiji Nishijima, Shiiki Satoh, and Jiro Tsugawa.
"MCRA of an Anastomotic Stenosis after Esophagoesophagostomy for Long Gap Esophageal Atresia: A
Case Report."Journal of Pediatric Surgery42.5 (2007): 769-72. Web.
Hendren, W. Hardy, and J. Richard Hale. "Electromagnetic Bougienage to Lengthen Esophageal Segments
in Congenital Esophageal Atresia."New England Journal of Medicine293.9 (1975): 428-32. Web.
Esophageal Atresia - Radiographic Features. Digital image.Pediatric Radiology. The University of Virginia,
2013. Web. <https://www.med-ed.virginia.edu/courses/rad/peds/abd_webpages/abdominal2b.html>.
Questions?