Sofia Morão, Filipa Marujo, P. Loureiro, D. Virella, R. Alves
A 3250g, female second twin, known antenatally to have an omphalocele and interventricular communication, was delivered by elective cesarean section (pelvic 1st twin) to a 33-year-old, G1P1, mother at 36 weeks’ gestation, at the referral tertiary level maternity of a university hospital center. It was a monochorionic diamniotic pregnancy through a donor in vitro fertilization. No obvious exposure to teratogens was documented during gestation. Both fetuses had negative karyotype for T21 and T13 and normal microarray.
{"title":"Heteropagus parasitic twins – a case of omphalopagus with major omphalocele and congenital heart disease","authors":"Sofia Morão, Filipa Marujo, P. Loureiro, D. Virella, R. Alves","doi":"10.47338/jns.v11.1091","DOIUrl":"https://doi.org/10.47338/jns.v11.1091","url":null,"abstract":"A 3250g, female second twin, known antenatally to have an omphalocele and interventricular communication, was delivered by elective cesarean section (pelvic 1st twin) to a 33-year-old, G1P1, mother at 36 weeks’ gestation, at the referral tertiary level maternity of a university hospital center. It was a monochorionic diamniotic pregnancy through a donor in vitro fertilization. No obvious exposure to teratogens was documented during gestation. Both fetuses had negative karyotype for T21 and T13 and normal microarray.","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44443655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Zouari, H. Ben Ameur, E. Krichen, N. Kraiem, M. Ben Dhaou, R. Mhiri
Congenital diaphragmatic hernia (CDH) is one of the most challenging neonatal conditions occurring in 3 in 10000 live births. [1] Despite considerable recent advances in perinatal resuscitation and neonatal care, CDH remains an important cause of mortality with rates ranging from 25% to 50%. [2-5] The leading causes of death in these patients are persistent pulmonary hypertension and severe lung hypoplasia. [6] Many researchers have studied the association between prognostic factors and mortality following surgical repair of CDH. However, these prognostic factors did not find widespread use due to conflicting results. Moreover, most studies regarding CDH outcomes are from developed countries. The management of these patients in developing countries is more challenging. In Tunisia, as in many developing countries, extracorporeal membrane oxygenation and synthetic patches are not available. The aim of this study was to assess risk factors for 30-day mortality following surgical repair of congenital diaphragmatic hernia in a single center in Tunisia.
{"title":"Large defect size is associated with 30-day mortality following surgical repair of congenital diaphragmatic hernia","authors":"M. Zouari, H. Ben Ameur, E. Krichen, N. Kraiem, M. Ben Dhaou, R. Mhiri","doi":"10.47338/jns.v11.1098","DOIUrl":"https://doi.org/10.47338/jns.v11.1098","url":null,"abstract":"Congenital diaphragmatic hernia (CDH) is one of the most challenging neonatal conditions occurring in 3 in 10000 live births. [1] Despite considerable recent advances in perinatal resuscitation and neonatal care, CDH remains an important cause of mortality with rates ranging from 25% to 50%. [2-5] The leading causes of death in these patients are persistent pulmonary hypertension and severe lung hypoplasia. [6] Many researchers have studied the association between prognostic factors and mortality following surgical repair of CDH. However, these prognostic factors did not find widespread use due to conflicting results. Moreover, most studies regarding CDH outcomes are from developed countries. The management of these patients in developing countries is more challenging. In Tunisia, as in many developing countries, extracorporeal membrane oxygenation and synthetic patches are not available. The aim of this study was to assess risk factors for 30-day mortality following surgical repair of congenital diaphragmatic hernia in a single center in Tunisia.","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47542605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Surgical intervention in neonates with Gastro-esophageal Reflux Disease (GERD) is usually reserved for failure of medical management or those having life-threatening complications of GERD. The optimal timing of intervention is still debatable. We aimed to identify the high-risk neonates with GERD requiring early surgical intervention. Methods: This prospective cohort study was conducted at NICU and Pediatric Surgery Department, Ain Shams University, from June 2017 to June 2020, and enrolled the neonates and infants below 2 months with symptoms and signs suggestive of GERD. Demographic data, clinical history, medical management, need for antireflux surgery, and outcomes were recorded. Results: In this study, 40 patients were enrolled and all were started on medical treatment. After the failure of medical management or life-threatening complications, 12 of these underwent anti-reflux surgery. In the medical group, six patients suffered from major complications (bronchopulmonary dysplasia and sepsis) and four mortalities. In the surgical group, three mortalities related to the development of bronchopulmonary dysplasia due to prolonged ventilation prior to surgery were recorded. The need for surgical intervention was significantly associated with younger gestational age (p = 0.001), younger age at presentation (p = 0.006), and lower weight at presentation (p = 0.034). Conclusion: Medical treatment of more than 35 days with unsatisfactory response, low birth weight, gestational age (≤32 weeks), and NICU admission in the first 10 days of life are considered high-risk factors for early anti-reflux surgery in neonates.
{"title":"Risk factors for early surgical intervention in neonates with gastroesophageal reflux disease","authors":"Shady S. Shokry, K. El-Asmar, M. Dahab, T. Hassan","doi":"10.47338/jns.v11.1033","DOIUrl":"https://doi.org/10.47338/jns.v11.1033","url":null,"abstract":"Background: Surgical intervention in neonates with Gastro-esophageal Reflux Disease (GERD) is usually reserved for failure of medical management or those having life-threatening complications of GERD. The optimal timing of intervention is still debatable. We aimed to identify the high-risk neonates with GERD requiring early surgical intervention.\u0000Methods: This prospective cohort study was conducted at NICU and Pediatric Surgery Department, Ain Shams University, from June 2017 to June 2020, and enrolled the neonates and infants below 2 months with symptoms and signs suggestive of GERD. Demographic data, clinical history, medical management, need for antireflux surgery, and outcomes were recorded.\u0000Results: In this study, 40 patients were enrolled and all were started on medical treatment. After the failure of medical management or life-threatening complications, 12 of these underwent anti-reflux surgery. In the medical group, six patients suffered from major complications (bronchopulmonary dysplasia and sepsis) and four mortalities. In the surgical group, three mortalities related to the development of bronchopulmonary dysplasia due to prolonged ventilation prior to surgery were recorded. The need for surgical intervention was significantly associated with younger gestational age (p = 0.001), younger age at presentation (p = 0.006), and lower weight at presentation (p = 0.034).\u0000Conclusion: Medical treatment of more than 35 days with unsatisfactory response, low birth weight, gestational age (≤32 weeks), and NICU admission in the first 10 days of life are considered high-risk factors for early anti-reflux surgery in neonates.","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43528020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The lesion was misdiagnosed elsewhere as laryngomalacia and spontaneous recovery were assured without intervention. Endoscopic evaluation was not done. The baby was brought to our center due to failure to thrive, feeding difficulty, repeated choking episodes, and worsening physical findings. Preoperative fiber optic laryngoscopy was done which revealed a cystic lesion at the vallecula obstructing the laryngeal inlet, pushing the epiglottis forward (Fig. 2). MRI scan showed a well-defined nonenhancing thin-walled cystic lesion measuring 14.8x14.2mm at vallecula and the diagnosis was confirmed (Fig. 3). Surgery was planned. Intubation was attempted but failed. The baby was tracheostomized before the procedure for ventilation, anticipating postoperative surgical site edema as well. Uncuffed tracheostomy tube size 3 was used. A direct laryngoscope straight blade with zero degree endoscope was held by the anesthetist to view the cyst and the EVAC-70 coblation wand was held in the right hand by the surgeon. The settings of the coblator were maintained at 70-30, coblation and coagulation respectively. The wand was used in both coblator and coagulation mode based on need. The anterior cyst wall was completely removed by coblation, and the cyst was thus marsupialized.
{"title":"Coblator assisted marsupialization of vallecular cyst","authors":"Pradeep Kumar, Lakshmi Venkitaraman","doi":"10.47338/jns.v11.1066","DOIUrl":"https://doi.org/10.47338/jns.v11.1066","url":null,"abstract":"The lesion was misdiagnosed elsewhere as laryngomalacia and spontaneous recovery were assured without intervention. Endoscopic evaluation was not done. The baby was brought to our center due to failure to thrive, feeding difficulty, repeated choking episodes, and worsening physical findings. Preoperative fiber optic laryngoscopy was done which revealed a cystic lesion at the vallecula obstructing the laryngeal inlet, pushing the epiglottis forward (Fig. 2). MRI scan showed a well-defined nonenhancing thin-walled cystic lesion measuring 14.8x14.2mm at vallecula and the diagnosis was confirmed (Fig. 3). Surgery was planned. Intubation was attempted but failed. The baby was tracheostomized before the procedure for ventilation, anticipating postoperative surgical site edema as well. Uncuffed tracheostomy tube size 3 was used. A direct laryngoscope straight blade with zero degree endoscope was held by the anesthetist to view the cyst and the EVAC-70 coblation wand was held in the right hand by the surgeon. The settings of the coblator were maintained at 70-30, coblation and coagulation respectively. The wand was used in both coblator and coagulation mode based on need. The anterior cyst wall was completely removed by coblation, and the cyst was thus marsupialized.","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48799618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Abdominal cocoon (AC) is the partial or complete encasement of the intestines and sometimes other abdominal organs by a fibro-collagenous sac causing varied presentations of intestinal obstruction. It has been found in all age groups from neonates to the elderly although neonatal AC is quite rare and only very few cases have been reported. In neonates, the presentation could mimic other causes of partial or complete intestinal obstruction and preoperative diagnosis is usually difficult. Case Presentation: We report an atypical sequela of intestinal malrotation causing neonatal intestinal obstruction due to omental encasement of the small and large bowel. The diagnosis was made intraoperatively though contrast gastrointestinal series suggested the partial obstruction at the duodenal-jejunal level. The patient made a good postoperative recovery after extraction of the bowel from the cocoon (omental sac), partial omentectomy, and Ladd’s procedure. Conclusion: A neonatal abdominal cocoon caused by an omental encasement in a malrotated intestine is a unique presentation and a rare cause of neonatal intestinal obstruction.
{"title":"Neonatal abdominal cocoon arising from atypical sequelae of intestinal malrotation: A case report","authors":"L. Abdur-Rahman, OA Ojajuni, TK Raji","doi":"10.47338/jns.v11.1057","DOIUrl":"https://doi.org/10.47338/jns.v11.1057","url":null,"abstract":"Background: Abdominal cocoon (AC) is the partial or complete encasement of the intestines and sometimes other abdominal organs by a fibro-collagenous sac causing varied presentations of intestinal obstruction. It has been found in all age groups from neonates to the elderly although neonatal AC is quite rare and only very few cases have been reported. In neonates, the presentation could mimic other causes of partial or complete intestinal obstruction and preoperative diagnosis is usually difficult.\u0000Case Presentation: We report an atypical sequela of intestinal malrotation causing neonatal intestinal obstruction due to omental encasement of the small and large bowel. The diagnosis was made intraoperatively though contrast gastrointestinal series suggested the partial obstruction at the duodenal-jejunal level. The patient made a good postoperative recovery after extraction of the bowel from the cocoon (omental sac), partial omentectomy, and Ladd’s procedure.\u0000Conclusion: A neonatal abdominal cocoon caused by an omental encasement in a malrotated intestine is a unique presentation and a rare cause of neonatal intestinal obstruction.","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46805831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Pulmonary lymphangiectasia (PL) is a rare disease characterized by dilation of the pulmonary lymphatic vessels. PL should be considered in the differential diagnosis in infants with pleural effusion, especially in the presence of chylothorax. Case Presentation: A 3-week-old neonate presented with tachypnea, cough, and reluctance to feed. Work-up found bilateral chylous pleural effusion. The patient was initially managed conservatively with bilateral tube thoracostomies and octreotide, however output from chest tubes did not subside. A left thoracotomy was performed with wedge biopsy of the apical segment of the left inferior lung lobe and multiple titanium clips were used to control thoracic duct. Postoperatively the patient continued to have high chest tube output, despite placement of clips. Histology of the biopsy confirmed the diagnosis of congenital pulmonary lymphangiectasia. Conclusion: Pulmonary lymphangiectasia is a rare cause of chylothorax. The treatment is often challenging as found in the index case.
{"title":"Pulmonary lymphangiectasia a rare cause of chylothorax: A case report","authors":"J. Conner, R. Mahon, J. Camps","doi":"10.47338/jns.v11.1037","DOIUrl":"https://doi.org/10.47338/jns.v11.1037","url":null,"abstract":"Background: Pulmonary lymphangiectasia (PL) is a rare disease characterized by dilation of the pulmonary lymphatic vessels. PL should be considered in the differential diagnosis in infants with pleural effusion, especially in the presence of chylothorax.\u0000Case Presentation: A 3-week-old neonate presented with tachypnea, cough, and reluctance to feed. Work-up found bilateral chylous pleural effusion. The patient was initially managed conservatively with bilateral tube thoracostomies and octreotide, however output from chest tubes did not subside. A left thoracotomy was performed with wedge biopsy of the apical segment of the left inferior lung lobe and multiple titanium clips were used to control thoracic duct. Postoperatively the patient continued to have high chest tube output, despite placement of clips. Histology of the biopsy confirmed the diagnosis of congenital pulmonary lymphangiectasia.\u0000Conclusion: Pulmonary lymphangiectasia is a rare cause of chylothorax. The treatment is often challenging as found in the index case.","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45644826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Acosta Farina, Verónica Polit-Guerrero, Johan Aguayo-Vistin, Cristhian Cedeño-Moreira, Vicente Salinas-Salinas, Daniel Acosta-Bowen, J. Oliveros-Rivero
Background: Functional Intestinal Obstruction of Prematurity (FIOP) is the delay or failure of meconium evacuation in premature neonates. It is associated with hypomotility in the developing intestine. It mostly presents with signs of intestinal obstruction in very low (VLBW) or extremely low birth weight (ELBW) neonates. Case Series: We present short-term results regarding the management of 8 premature newborns with FIOP treated with Awolaran O. et al [1] algorithm in a pediatric hospital, two of them required a surgical procedure due to conservative management failure. Conclusion: Early conservative management is successful in most patients with FIOP, related to symptom resolution. Surgical management should be kept for those with conservative management failure.
{"title":"Functional Intestinal Obstruction of Prematurity (FIOP): Short term management results: A case series","authors":"D. Acosta Farina, Verónica Polit-Guerrero, Johan Aguayo-Vistin, Cristhian Cedeño-Moreira, Vicente Salinas-Salinas, Daniel Acosta-Bowen, J. Oliveros-Rivero","doi":"10.47338/jns.v11.1048","DOIUrl":"https://doi.org/10.47338/jns.v11.1048","url":null,"abstract":"Background: Functional Intestinal Obstruction of Prematurity (FIOP) is the delay or failure of meconium evacuation in premature neonates. It is associated with hypomotility in the developing intestine. It mostly presents with signs of intestinal obstruction in very low (VLBW) or extremely low birth weight (ELBW) neonates.\u0000Case Series: We present short-term results regarding the management of 8 premature newborns with FIOP treated with Awolaran O. et al [1] algorithm in a pediatric hospital, two of them required a surgical procedure due to conservative management failure.\u0000Conclusion: Early conservative management is successful in most patients with FIOP, related to symptom resolution. Surgical management should be kept for those with conservative management failure.","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49148888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Despite great advances in the overall management of neonates with esophageal atresia (EA), many complications leading to morbidity still occurs. Most complications can be treated conservatively, but effective management is needed to reduce long-term morbidity. Methods: A retrospective cohort study was performed on neonates treated for EA with/without a tracheoesophageal fistula (TEF) between 2001 and 2020. Data were collected from patient records, discharge summaries, and surgical notes. The information recorded included: maternal and neonatal demographics, information regarding the diagnosis, and details surrounding the surgery. Results: During the 19-year study period, 53 neonates with a mean gestational age of 36.7 weeks were included for analysis. Forty-nine percent presented with an associated anomaly (most commonly, complex cardiac lesions). The majority (83%) had a primary repair on a median of day 3 of life. Nineteen neonates had a surgical complication 30 days post-repair: 7 minor (contained leaks and a chylothorax) and 12 major complications including anastomotic strictures, major anastomotic breakdowns, a recurrent TEF, and 5 surgery-related mortalities. Conclusions: This study showed less morbidity and mortality of neonates born with EA, despite a high incidence of associated anomalies, in a resource-restricted hospital. It is important to highlight that even with limited resources, centers in low- or middle-income countries can have good outcomes.
{"title":"The 30-day outcome of neonates operated for esophageal atresia","authors":"C. de Vos, L. van Wyk, D. Sidler, P. Goussard","doi":"10.47338/jns.v11.1049","DOIUrl":"https://doi.org/10.47338/jns.v11.1049","url":null,"abstract":"Background: Despite great advances in the overall management of neonates with esophageal atresia (EA), many complications leading to morbidity still occurs. Most complications can be treated conservatively, but effective management is needed to reduce long-term morbidity. \u0000Methods: A retrospective cohort study was performed on neonates treated for EA with/without a tracheoesophageal fistula (TEF) between 2001 and 2020. Data were collected from patient records, discharge summaries, and surgical notes. The information recorded included: maternal and neonatal demographics, information regarding the diagnosis, and details surrounding the surgery.\u0000Results: During the 19-year study period, 53 neonates with a mean gestational age of 36.7 weeks were included for analysis. Forty-nine percent presented with an associated anomaly (most commonly, complex cardiac lesions). The majority (83%) had a primary repair on a median of day 3 of life. Nineteen neonates had a surgical complication 30 days post-repair: 7 minor (contained leaks and a chylothorax) and 12 major complications including anastomotic strictures, major anastomotic breakdowns, a recurrent TEF, and 5 surgery-related mortalities.\u0000Conclusions: This study showed less morbidity and mortality of neonates born with EA, despite a high incidence of associated anomalies, in a resource-restricted hospital. It is important to highlight that even with limited resources, centers in low- or middle-income countries can have good outcomes.","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45231609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Posterolateral muscle cutting thoracotomy is the gold standard approach to repair esophageal atresia with distal tracheoesophageal fistula. This technique is associated with morbidities in terms of poor motor and aesthetic outcomes. We aim to share our experience with muscle-sparing skin crease incision posterolateral thoracotomy for esophageal atresia Vogt type 3b. Methods: It was a retrospective observational study conducted over a period of 3 years and 6 months from January 2016 to June 2019 at two tertiary care teaching institutes. All patients with esophageal atresia having distal tracheoesophageal fistula were included. Results: Fifty-nine neonates underwent muscle-sparing thoracotomy, with 23 males and 36 females. The 34 (58%) neonates had low birth weight. Anorectal malformation (ARM) was the most common (6) associated major malformation(18). Intraoperative findings included long gap EA (6), right aortic arch (RAA, 3), aberrant vessels (1), and long upper pouch (1). Conversion to muscle cutting approach (during early learning curve) was performed in 8 cases i.e. long gap EA (3), RAA (2), Subglottic stenosis (2), others (1). No intraoperative complication was encountered; postoperative seroma formation (related to the approach) was observed in 2 (3.4%) neonates. Most of the patients achieved satisfactory functional and aesthetic outcomes. Conclusions: Muscle-sparing skin crease incision posterolateral thoracotomy is a viable approach for repair of esophageal atresia with distal tracheoesophageal fistula. The technique is easy to perform with adequate exposure and provides satisfactory functional and aesthetic outcomes with relatively minimum morbidity.
{"title":"Muscle-sparing posterolateral thoracotomy for esophageal atresia Vogt Type 3b","authors":"Rahul Gupta","doi":"10.47338/jns.v11.1074","DOIUrl":"https://doi.org/10.47338/jns.v11.1074","url":null,"abstract":"Background: Posterolateral muscle cutting thoracotomy is the gold standard approach to repair esophageal atresia with distal tracheoesophageal fistula. This technique is associated with morbidities in terms of poor motor and aesthetic outcomes. We aim to share our experience with muscle-sparing skin crease incision posterolateral thoracotomy for esophageal atresia Vogt type 3b. \u0000Methods: It was a retrospective observational study conducted over a period of 3 years and 6 months from January 2016 to June 2019 at two tertiary care teaching institutes. All patients with esophageal atresia having distal tracheoesophageal fistula were included. \u0000Results: Fifty-nine neonates underwent muscle-sparing thoracotomy, with 23 males and 36 females. The 34 (58%) neonates had low birth weight. Anorectal malformation (ARM) was the most common (6) associated major malformation(18). Intraoperative findings included long gap EA (6), right aortic arch (RAA, 3), aberrant vessels (1), and long upper pouch (1). Conversion to muscle cutting approach (during early learning curve) was performed in 8 cases i.e. long gap EA (3), RAA (2), Subglottic stenosis (2), others (1). No intraoperative complication was encountered; postoperative seroma formation (related to the approach) was observed in 2 (3.4%) neonates. Most of the patients achieved satisfactory functional and aesthetic outcomes. \u0000Conclusions: Muscle-sparing skin crease incision posterolateral thoracotomy is a viable approach for repair of esophageal atresia with distal tracheoesophageal fistula. The technique is easy to perform with adequate exposure and provides satisfactory functional and aesthetic outcomes with relatively minimum morbidity.","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45842316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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