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DOI: 10.1055/s-0044-1779042
Repair of Complex Esophageal Atresia with Tracheobronchial Remnant using Special Magnets
Funding This work was supported by federal grants from the U.S. Food and Drug Administration UCSF-Stanford Pediatric Device Consortium, San Francisco, CA (#P50FD003793) and the U.S. Food and Drug Administration West Coast Consortium for Technology and Innovation in Pediatrics, Los Angeles, CA (#P50F006425). Sponsors were not involved in patient selection, data collection or interpretation, manuscript preparation, or the decision to submit this article for publication.
Abstract
Esophageal atresia (EA) repair can be complicated by associated malformations such as a tracheobronchial remnant in the distal esophagus. We describe our experience with a patient found to have long-gap EA with a distal cartilaginous ring who was managed using a combination of esophageal lengthening and magnetic compression anastomosis. A 5-month-old girl was referred to us from an outside hospital with type C EA including a very high upper pouch. She had undergone a prior thoracotomy with fistula ligation during which a clip was placed on the lower esophagus, leaving a 2-cm diverticulum on the trachea and a short lower esophageal pouch. Upon endoscopic evaluation at our center, we found a tracheobronchial remnant in the lower esophagus between the clip and the carina. An open thoracotomy was performed to approximate the esophageal pouches and a magnet anchor (Connect EA, Myka Laboratories, San Francisco, California, United States) was placed retrograde through the distal esophageal cartilaginous ring into the lower pouch. On postoperative day 8, after adequate growth and decreased pouch tension, a second magnetic anchor was placed endoscopically to the upper pouch to mate with the previously placed lower pouch anchor. The anastomosis formed within 14 days. Due to the tracheobronchial remnant, the device did not pass distally and was removed endoscopically. On postoperative day 8, balloon dilation of the anastomosis and tracheobronchial remnant was performed. Subsequently, the patient required a total of 6 dilations in an 18-month follow-up. This case report illustrates the utility of using magnets to create an esophageal anastomosis in complex cases of EA with concomitant esophageal malformations. The parents of the patient gave their written consent to publish this technical report.
Authors’ Contributions
C.R. and E.W. played crucial roles in writing the original draft, conducting investigations, and contributing to formal analysis. A.S.H. dedicated efforts to investigation and methodology, while M.H. significantly contributed to conceptualization, methodology, and provided essential resources. W.L. contributed expertise in reviewing and editing, along with valuable input into methodology. O.M. took charge of conceptualization, methodology, and actively participated in the writing, reviewing, and editing processes.
Publikationsverlauf
Eingereicht: 01. Juli 2023
Angenommen: 21. Oktober 2023
Artikel online veröffentlicht:
02. Februar 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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