bluuebunny/crossref_metadata_2025_split huggingface dataset:
DOZ047.12: A comparative analysis of concerns of caregivers with repaired esophageal Atresia-Tracheoesophageal fistula
Authors: Arslan S S , Türer Ö B , Demir N , Karaduman A , Tanyel F C , Soyer T 
Published: June 2019

Abstract

Aim
Children with esophageal atresia and tracheoesophageal fistula (EA-TEF) may experience feeding and swallowing difficulties, which result in stressful interactions between children and caregivers, and potentially impact the concerns of caregivers. The aim of this study was to assess concerns of caregivers of children with EA-TEF related to feeding–swallowing difficulties and compare the concerns according to type of atresia, repair time and time to start oral feeding.

Methods
Caregivers accompanying 24 children with EA-TEF were included. Age, sex, type of atresia, repair time, and time to start oral feeding of children were noted. Parents completed the Feeding/Swallowing Impact Survey (FS-IS) to assess the concerns of caregivers related to feeding–swallowing difficulties. It has three subscales, including daily activities, worry, and feeding difficulties. Average scores range between 1 and 5, of which increasing scores reflect more caregiver concern.

Results
The mean age was 3.41 ± 2.71 years, of which 66.7% were male. 56.3% of cases were isolated EA, and 43.8% were EA–distal TEF. 60.9% of cases received early repair (<1 month of age), and 39.1% had delayed repair (between 1 and 12 months). The median time to start oral feeding was 4 weeks (min = 2, max = 128). The mean scores of daily activities, worry, feeding difficulties, and the total score were 2.40 ± 1.01, 2.79 ± 1.06, 2.14 ± 0.95, and 2.49 ± 0.88, respectively. Caregivers of children with isolated EA reported more problems with ‘daily activities’, ‘feeding difficulties’, and ‘total score’ than EA–distal TEF (P < 0.05). Caregivers of children who received delayed repair reported more problems with the ‘daily activities’ subscale and ‘total score’ than children with early repair (P < 0.05). Moderate to strong correlations were found between the ‘daily activities’ and ‘feeding difficulties’ subscales of FS-IS and time to start oral feeding (P < 0.05, r = 0.56–0.69).

Conclusions
This study suggests that concerns of caregivers of children with EA-TEF related to feeding–swallowing difficulties are associated with the surgical outcome of EA. Caregivers of children with isolated-EA and/or delayed repair and/or delay in oral intake may have higher concerns related to feeding–swallowing difficulties.
DOZ047.123: Choose typology: oral communication multiple congenital bronchogenic cysts and thyroglossal duct remnant, case report
Authors: Attya H , Gupta S L 
Published: June 2019

Abstract

Background
Thyroglossal duct remnants, most frequently presenting as cysts, are the most common congenital anomalies of the neck. Bronchogenic cysts are rare congenital anomalies of the primitive foregut and are a subtype of foregut supplication cysts. Those cysts are the most common cystic lesions of the mediastinum. They can present in other areas such as the neck. Such cystic lesions are usually seen in pediatric population and symptomology depends on the location, size and degree of compression to the surrounding structures. The synchronous presence of both lesions in one patient is rare. To the best of our knowledge, such presentation has not been reported in the literature. We present a case of multiple lesions in the neck and mediastinum including precricoid, paraglotttic and paratracheal regions.

Case Presentation
A full-term male newborn presented in day 1 post normal vaginal delivery with progressive stridor and decreased feeding. Urgent airway endoscopy revealed a left supraglottic cyst and proximal non pulsatile tracheal wall compression by another cystic lesion. Aspiration of the supraglottic cyst was done and one month later, he developed stridor again for which he had endoscopic marsupialization of right supraglottic cyst and internal aspiration of paratracheal cyst. MRI showed right paratracheal cystic lesion with evidence of a tubular tract and an infected cyst inferiorly. Decision was made to explore the neck for definite removal of the cysts. Three lesions were identified: a precricoid mass, and paraglottic and paratracheal cysts. Cervical lesions were carefully dissected and excised. For the paratracheal cyst which extended to the mediastinum, incision and drainage was done and part of cyst wall was excised, and a drain inserted into the cyst. Histopathology confirmed the precrcoid lesion to be a thyroglossal duct remnant, the paraglottic cyst in keeping with bronchogenic cyst and the paratracheal cyst wall showed granulation tissue.

Discussion
The fact that the embryological basis for development of thyroglossal duct cyst and bronchogenic cyst is different makes diagnosis of both lesions is challenging and such presentation is unique. Definite diagnosis depends on accurate history, imaging particularly MRI and histopathology. Surgery is the treatment of choice for symptomatic cases.
DOZ047.124: Thoracoscopic anatomy of long-gap esophageal atresia. What can we predict?
Authors: Rasiewicz M , Świątek K , Gerus S , Patkowski D 
Published: June 2019

Abstract
Since the very beginning in 1999, thoracoscopic repair of esophageal atresia has become a gold standard in many pediatric surgery centers worldwide. Despite the advances in surgical technique, treatment of long-gap esophageal atresia still remains a challenge.
The aim of this study is to assess whether the localization of esophageal stumps can predict number of stages needed to perform anastomosis.
We analyzed video records of 21 patients who underwent staged thoracoscopic repair of long-gap esophageal atresia using internal traction technique. All procedures were performed by the same surgeon. We divided patients into two groups: first requiring single internal traction procedure, second who underwent multiple procedures. We assessed esophageal stump position in relation to thoracic vertebrae. The distance between stumps was measured in vertebral bodies.
Mean distance between esophageal ends was 5.8 in single traction group. The distance between the stumps was significantly greater in multiple procedures group: 7.33 (P = 0.003). Patients who required multiple procedures had significantly lower localization of distal stump. Localization of proximal stump did not affect the possibility for anastomosis after single traction. Distance between both ends after internal traction was also significantly longer in multiple procedures group.
Patients with lower localization of distal esophageal stump assessed during primary thoracoscopy are at higher risk for requiring multiple surgical procedures.
DOZ047.15: Esophageal anastomosis diameter at initial endoscopy after surgery predicts treatment outcomes in patients with esophageal atresia or stricture
Authors: Clark S J , Ngo P D , Staffa S J , Smithers C J , Hamilton T E , Jennings R , Manfredi M A 
Published: June 2019

Abstract

Background
Children with esophageal atresia (EA) are at risk for anastomotic stricture that may ultimately need surgical resection. No studies have examined the relationship between anastomotic diameter at the time of initial postop endoscopy and treatment outcomes.

Methods
A retrospective chart review was performed of patients with EA who underwent a Foker procedure for repair of long-gap esophageal atresia (LGEA), primary repair of EA, or stricture resection for refractory stricture who were seen between January 2016 and May 2018. A refractory stricture was defined as one requiring ≥5 dilations ≤5 months after surgery. The anastomosis diameter was estimated by the endoscopist. We divided diameter sizes into the following groups: 1–2.9 mm, 3–4.9 mm, 5–6.9 mm, 7–8.9 mm, 9–10.9 mm, and 11–14 mm. The Wilcoxon rank sum test and Fisher's exact test were used.

Results
Forty-five patients who had a Foker procedure, 37 who had primary repair, and 58 who had stricture resection were identified. The first EGD occurred a median of 22 days (IQR 21–28) after surgery. Among all EA patients with initial diameter of <3 mm, 82% developed refractory stricture and 41% required stricture resection. Of all patients with initial diameter <5 mm, 74% developed refractory stricture and 33% required stricture resection. Of patients who underwent a Foker procedure with initial diameter <3 mm, 56% required stricture resection; of these patients with initial diameter <5 mm, 53% required stricture resection. Among all EA patients, refractory strictures were significantly more likely in patients with smaller initial diameters (P < 0.001), from 18 patients (82%) with stricture 1–2 mm to 0 patients (0%) with stricture 11–14 mm. Patients with smaller anastomoses were more likely to need stricture resection (P = 0.020); 9 patients (41%) with size 1–2 mm underwent stricture resection, while none (0%) with size 11–14 mm needed stricture resection. These differences remained statistically significant for patients who underwent a Foker procedure (P ≤ 0.001 for stricture resection and refractory stricture).

Conclusion
Endoscopy performed shortly after EA repair or stricture resection can help predict which patients are more likely to develop a refractory stricture or require a stricture resection.
DOZ047.26: Longitudinal motor development from infancy to adolescence in children with esophageal atresia
Authors: Møinichen U I , Mikkelsen A , Faugli A , Holm I , Jsselstijn H I , Emblem R 
Published: June 2019

Abstract

Introduction
Motor performance may be affected in children with esophageal atresia (EA), but the development of motor performance from infancy to adolescence has not been properly studied. We have followed EA patients from one to 15 years of age and assessed development of motor performance.

Methods
Of 44 EA patients, born 1999–2002, 3 died, 6 with missing data, 4 excluded, and 10 refused to participate. Of 21 children were included. Perinatal data collected from medical records, and physical therapy was registered. The children were evaluated with The Bayley Scale of Infant Development-Second Edition at one year of age, and re-evaluated in adolescence with The Motor Assessment Battery for Children Second Edition. Both tests are well validated for fine and gross motor performance. The motor performances was categorized as normal, at risk or delayed at both evaluations.

Results
Of 21 EA children (GA 38.7, range: 34–40.7), 4 (19%) were premature, 18 (86%) had Gross type C, major cardiac anomaly in 1, VACTERL in 4 (19%).
At 15.1 months, 19/21 (90%) had motor performance within normal range, 1 child had delayed motor performance, and 1 child at risk for motor delay.
At 15 years 15/21 (71%) had motor performance within normal range, 3/21 (14%) children showed delayed motor performance and 3/21 (14%) at risk for motor delay. 5/21 (24%) EA patients had deteriorated and 1/21 (5%) remained delayed in motor performance, when grown up from 1 to 15 years of age. The gross motor function most often affected in adolescence was the balance skills.
Impaired motor performance was correlated to prematurity (r = .499, P = .021), but not to other perinatal morbidity factors.
The EA patients had not been offered systematic follow-up physical therapy program during childhood.

Conclusion
Motor performance was within normal range in 90% of the EA infants, but in adolescence, only 71% of the patients showed normal motor performance. However, at one year of age it is hard to distinguish the children who have mild motor delay. Close monitoring in childhood might help to diagnose them earlier and offer appropriate intervention.
DOZ047.28: Clinical utility of cardiopulmonary exercise testing in children with esophageal atresia
Authors: Belessis Y , McBride J , Plush L , Purcell M , Field P 
Published: June 2019

Abstract

Background
Respiratory morbidity in children with esophageal atresia/tracheoesophageal fistula (OA/TOF), due to impaired mucociliary clearance, recurrent infections, and aspiration, may impair pulmonary function during childhood and this may persist into adult life. Early recognition of reduced lung function could optimize respiratory management and improve long-term outcomes. However, static lung function assessments, using spirometry and body plethysmography, may not sensitively identify impaired lung function. Cardiopulmonary exercise testing (CPET), which involves a dynamic assessment of respiratory function and determines aerobic capacity, degree of fitness, and ventilatory (breathing) reserve during maximal exertion, may detect poor lung function earlier.

Aim
This study determines the clinical utility of cardiopulmonary exercise testing in children with OA/TOF.

Methods
Retrospective chart review of children attending a multidisciplinary OA/TOF clinic who underwent spirometry, plethysmography, and a maximal CPET (Bruce Treadmill Protocol). Plethysmography and CPET were performed on the same day in 16 children; 4 children within 2 days and 6 within 2 months. Studies exceeding 2 months were not analyzed (n = 2).

Results
Thirty-nine children, aged ≥ 7 years, underwent CPET when clinically well. Thirty-two children, 7–18 years, achieved a maximal CPET (82.1%). There was no significant exercise-induced drop in PPFEV1 in any child. One child experienced a reduction in oxygen saturation to 92%. Exercise capacity (VO2MAX, peak oxygen consumption) was normal in 30 children (93.8%). However reduced ventilatory or breathing reserve (BR), defined as <20% predicted, was identified in 18 children (56.3%). Four of these children had no ventilatory reserve (BR = 0). In contrast, spirometry was normal in 20 children (62.5%). Nine (28%) had a mild obstructive or restrictive pattern. One child had moderate restriction and 2 had a mixed pattern. Plethysmography (n = 26) revealed mild restrictive lung disease in 9 (34.6%). An additional 3 children had air-trapping.

Conclusion
Children with OA/TOF have significant lung function impairment. Spirometry and plethysmography revealed normal or mildly abnormal airway function/lung volumes in the majority of children. CPET identified significant ventilation limitation in over half of all children. CPET assessment is a feasible and sensitive assessment of cardiorespiratory function in children with OA/TOF. Further evaluation of risk factors and longitudinal CPET assessments may inform future management guidelines.
DOZ047.38: 10-years of experience with thoracoscopic approach for congenital H-type tracheoesophageal fistulas
Authors: Dzielendziak A , Toczewski K , Śmigiel R , Patkowski D 
Published: June 2019

Abstract

Introduction
Isolated H-type tracheoesophageal fistula has been distinguished in the group of congenital anomalies of the trachea and esophagus. It is a rare defect that causes diagnostic difficulties even for experienced clinicians.

Material and Methods
A retrospective analysis of the medical history of patients, who were operated in the Department of Pediatric Surgery and Urology in Wroclaw between 2009 and 2018 due to H-type tracheoesophageal fistula, was performed.

Results
The study group consists of 7 patients (4 boys and 3 girls). The diagnosis was made postnatally between 1 day of life and 4 months of age. The spectrum of symptoms was broad and varied from saturation disturbances to difficulties in food intake and recurrent pneumonia. In all patients, a contrast study was performed (the result of which was not always unambiguous).
After diagnosis of the H-type fistula in bronchoscopy, the thoracoscopy was performed. All procedures were performed using 5 mm scope and 3 mm instruments. The pressure used during procedures was between 3 and 6 mmHg. All patients underwent right-sided thoracoscopy. To help with fistula identification in 3 patients, an urethral catheter was left in the fistula during the bronchoscopy. The size and appearance of fistulas were variable. Clips or sutures were used to close the fistulas. After surgery, the nasogastric tube was left in the esophagus for 7 days. After a control contrast study, the tube was removed and the full oral feeding was started. In 6 patients, the primary procedure turned out to be the final and no complications were observed in the postoperative course. In one patient in the postoperative course, the chylothorax was observed, the treatment of which required a rethoracoscopy with successful local tissue electrocoagulation.

Conclusions
The congenital isolated tracheoesphageal fistula is a rare disorder. It causes unspecific clinical symptoms, therefore the diagnosis is often difficult. The thoracoscopic access in the hands of skilled surgeon is a safe method and should be the treatment of choice.
DOZ047.49: Tracheoscopic findings and their impact on respiratory symptoms in children with esophageal atresia
Authors: Janina F , Josef H , Grigore C , Martin D 
Published: June 2019

Introduction
Esophageal atresia is often accompanied by tracheobronchial malformations leading to stridor, recurrent bronchitis and occasionally to life threatening obstructive apnea after surgical repair. The aim of this study was to identify the presence of tracheomalacia in patients with esophageal atresia (EA) and tracheo-esophageal fistula (TEF) pre- and postoperatively and to find endoscopic correlates leading to clinical airway symptoms.

Methods
In a cohort of 362 patients with EA-TEF who underwent 595 tracheoscopies at the Children's Hospital of Cologne between January 1983 and December 2002, impaired tracheal lumen, localization of TEF, tracheal pulsations and corresponding clinical symptoms were retrospectively analyzed.

Results
The incidence of tracheomalacia was higher in patients with EA and TEF (Gross B, C, D) compared to patients with EA alone (Gross A) and average tracheal collapse does not significantly change before and after surgical repair of the esophagus in all types. Patients with cyanosis while eating and obstructive apnea presented with an average tracheal collapse of 89%. Presence of respiratory symptoms like cough, stridor or bronchitis was not associated with a higher grade of tracheal collapse compared to patients without any airway symptoms (average tracheal collapse of 37% in symptomatic patients vs. 33% in non-symptomatic patients).

Conclusion
Tracheomalacia tends to be present independently of surgical procedure. Tracheomalacia should be measured by tracheoscopy (in % of tracheal collapse). Patients with a tracheal collapse of > 80%, a ventral pulsation and obstructive apnea or cyanosis in combination, are at risk for life threatening situations.
DOZ047.59: Development of operational tactics for esophageal atresia in the Republic of Tatarstan (Russia)
Authors: Podshivalin A , Sageeva G , Lvov A 
Published: June 2019

Abstract
The Children's Republican Hospital of Kazan was opened in 1977 with the participation of prof. Rokytskyi, with rapid thoracic surgery development. In atresia of the esophagus, right-sided median thoracotomy, ligation of the tracheoesophageal fistula, Hayat esophagoplasty were performed. The duration of the operation was 2–3-4 h. With the installation of a pleural drainage for 2–3 weeks and a nasogastric tube for 1 month. When radical surgery was impossible, the upper and lower esophagostomas were applied, followed by coloesophagoplasty in 2–3 years. In 2003, the reconstruction and renovation of the surgical and resuscitation departments for neonates began. A new neonatal surgery team had been formed, studying in Ospedale Giannina Gaslini, Genova, Italy and St. Petersburg, Russia. As a result we introduced a single-row suture into the neonatal surgery for esophagoplasty. The duration of drainage was 7–10 days, the duration of the nasogastric tube was 2 weeks. The duration of hospital stay was reduced to 1–1.5 months. Another, ‘stormy’ development of neonatal surgery has undergone in 2013. The accumulated experience in the open surgery of the esophagus allowed us to begin to perform thoracoscopic esophagoplasty. Starting from 2013, more than 20 patients are operated annually with esophageal atresia of various forms. Mortality of about 3% in 5 years. We perform thoracoscopy, ligation and resection of tracheoesophageal fistula, end-to-end esophagoplasty with various diastasis. Esophageal anastomosis nodular extracarporal single row. The minimum weight of a patient with thoracoscopic esophagoplasty is 1200 g. The term draining of the pleural cavity is 3–5 days. A complicated group of patients consists of newborns with Long Gap. The final choice of surgical tactics is not yet decided. The primary and obligatory operation that is performed in LG is gastrostomy to feed the patient, with previous thoracoscopy and resection of the tracheoesophageal fistula with type 3 esophageal atresia. At the age of 2 weeks, gastroscopy and gastrography are performed in order to determine the diastasis between the esophagus. In conclusion, it is necessary to say the following. We consider thoracoscopic access for esophageal pathology as optimal, providing the patient with weighs more than 1200 g and without no concomitant pathology.
DOZ047.64: Sham feeding promotes oral feeding success in long-gap esophageal atresia, even with traction sutures in situ
Authors: Hawley A D , Armstrong R K , Brooks J-A E , Pellicano A , Nightingale M G , Crameri J , Teague W J 
Published: June 2019

Abstract

Introduction
Sham feeding (SF) and staged repair using traction suture techniques (TST) were both introduced to the management of long-gap esophageal atresia (LGOA) at The Royal Children's Hospital, Melbourne (RCH) in January 2012. Previous studies report SF to reduce time to full oral feeding (FOF) postdefinitive repair. In our practice, SF is individually tailored, supervised, and involves offering 2–4 feeds daily. This single-center experience describes SF in newborns with LGOA, including those with staged TST prior to definitive repair, and the impact of SF on time to FOF.

Methods
Patients admitted 2000–2018 with LGOA were identified from the Nate Myers Oesophageal Atresia Database, RCH. Those with incomplete data or complications preventing oral feeds were excluded. Patients were grouped into two epochs: Group 1 (2000–2011, no SF, no TST) and Group 2 (2012–2018, all offered SF, some TST). Demographics and time to FOF were compared between groups. Parametric data (mean, SD) were analyzed with two sample t-test, and nonparametric data (median, IQR) with Mann–Whitney test; P < 0.05 significant. Ethics approval was obtained (HREC#QA/51247/RCHM-2019).

Results
Of 37 LGOA patients, six met exclusion criteria leaving 31 for analysis; Group 1, n = 13; Group 2, n = 18. Groups did not differ in gestation (P = 0.63), birth weight (P = 0.91) or time to definitive repair (P = 0.85). In Group 2, 12/18 had successful SF, including 9 who underwent TST. Three additional patients with TST were unsuccessful with SF. Compared with Group 1, FOF was significantly reduced in those 12 patients with successful SF (median FOF 730 days, IQR 125–1100 vs. median FOF 75 days IQR 56–227; P = 0.03). Small sample size precluded meaningful subgroup analyses of successful versus unsuccessful SF patients. Importantly, no patient aspirated during SF, though one developed oral aversion post-TST and one ceased SF at parental request.

Conclusions
In LGOA, successful SF improves time to FOF postdefinitive repair, and was not associated with aspiration in our experience. Further, we report success with SF in patients undergoing staged repair with TST, including following traction suture placement. To our knowledge, this is the first report of SF in LGOA patients during the period between traction suture placement and definitive repair.