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     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
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LETTER TO EDITOR
Year : 2011  |  Volume : 16  |  Issue : 1  |  Page : 34
 

Esophageal atresia with tracheo-esophageal fistula: Making anastomosis easy


Pediatric Surgery Centre and PG Institute, Vishrambag, Sangli - 416 415, India

Date of Web Publication3-Jan-2011

Correspondence Address:
Sudhakar Jadhav
Pediatric Surgery Centre and PG Institute, Vishrambag, Sangli - 416 415
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.74522

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How to cite this article:
Jadhav S, Kittur D, Vora R, Sarode V, Raut A, Mandke J. Esophageal atresia with tracheo-esophageal fistula: Making anastomosis easy. J Indian Assoc Pediatr Surg 2011;16:34

How to cite this URL:
Jadhav S, Kittur D, Vora R, Sarode V, Raut A, Mandke J. Esophageal atresia with tracheo-esophageal fistula: Making anastomosis easy. J Indian Assoc Pediatr Surg [serial online] 2011 [cited 2019 Jul 22];16:34. Available from: http://www.jiaps.com/text.asp?2011/16/1/34/74522


Sir,

In India, the results of esophageal atresia and tracheo-esophageal fistula depend on many factors like birth weight, associated cardiac defects, underlying pneumonia, etc. to name a few. The duration of surgery has a direct bearing on the post-operative morbidity and mortality. Keeping this in mind, the extrapleural approach is adopted by most to minimize the lung problems should the anastomosis leak. But, the retraction of the lung and mediastinum, hypoxemia, frequent interruption to dissection and anastomosis of the two ends cause a hindrance for smooth operation.

Because the results following a transpleural and extrapleural approach are comparable, we have added a manoeuver to the usual steps of the operation, which not only makes the dissection and anastomosis easy but also reduces the operating time, which is important especially in a baby having underlying pneumonia.

After taking a deliberate transpleural approach under relaxant anesthesia, the three lobes of the right lung are brought out one after the other and retracted by a tape made of wet gauze that is held just distal to the hilum. The assistant retracts just enough to allow inflation of all the lobes all the time during the surgery.

This maneuver not only brings the mediastinal structures about 3.5-5 cm superficial into the wound but also allows the surgeon to complete the dissection and anastomosis of the esophageal ends without interruption. The anesthesiologist is at ease as he can watch the lobes being inflated all the time along with the oxygen saturation above 95%.

We have used this technique in 110 patients in the last 7 years and have found that the operation is smooth, the post-operative lung problems are fewer and the end result is comparable with that of my colleagues who prefer an extrapleural approach in infants with weight above 2.0 kg and especially those with underlying lung insult.

Some of our colleagues are following this approach and I wish to appeal to my colleagues to give it a try. Those who wish to have a video clipping of the manoeuver may please write to me on the address given below.




 

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