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- Title
The multi-disciplinary management of complex congenital and acquired tracheo-oesophageal fistulae.
- Authors
Thakkar, H. S.; Hewitt, R.; Cross, K.; Hannon, E.; De Bie, F.; Blackburn, S.; Eaton, S.; McLaren, C. A.; Roebuck, D. J.; Elliott, M. J.; Curry, J. I.; Muthialu, N.; De Coppi, P.
- Abstract
<bold>Aim Of the Study: </bold>Complex tracheo-oesophageal fistulae (TOF) are rare congenital or acquired conditions in children. We discuss here a multidisciplinary (MDT) approach adopted over the past 5 years.<bold>Methods: </bold>We retrospectively collected data on all patients with recurrent or acquired TOF managed at a single institution. All cases were investigated with neck and thorax CT scan. Other investigations included flexible bronchoscopy and bronchogram (B&B), microlaryngobronchoscopy (MLB) and oesophagoscopy. All cases were subsequently discussed in an MDT meeting on an emergent basis if necessary.<bold>Main Results: </bold>14 patients were referred during this study period of which half had a congenital aetiology and the other half were acquired. The latter included button battery ingestions (5/7) and iatrogenic injuries during oesophageal atresia (OA) repair. Surgical repair was performed on cardiac bypass in 3/7 cases of recurrent congenital fistulae and all cases of acquired fistulae. Post-operatively, 9/14 (64%) patients suffered complications including anastomotic leak (1), bilateral vocal cord paresis (1), further recurrence (1), and mortality (1). Ten patients continue to receive surgical input encompassing tracheal/oesophageal stents and dilatations.<bold>Conclusions: </bold>MDT approach to complex cases is becoming increasingly common across all specialties and is important in making decisions in these difficult cases. The benefits include shared experience of rare cases and full access to multidisciplinary expertise.
- Subjects
FISTULA; OSTEOARTHRITIS; BRONCHOSCOPY; NECK; VOCAL cords; DECISION making; TRACHEAL surgery; COMPARATIVE studies; COMPUTED tomography; ESOPHAGOPLASTY; ESOPHAGEAL atresia; TRACHEAL fistula; RESEARCH methodology; MEDICAL cooperation; RESEARCH; DISEASE management; DISEASE relapse; EVALUATION research; RETROSPECTIVE studies; MULTIPLE human abnormalities
- Publication
Pediatric Surgery International, 2019, Vol 35, Issue 1, p97
- ISSN
0179-0358
- Publication type
journal article
- DOI
10.1007/s00383-018-4380-8