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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.
Publication History
Received: 01 July 2023
Accepted: 21 October 2023
Article published online:
02 February 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/)
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References
- 1 Møinichen UI, Mikkelsen A, Gunderson R. et al. New insights in the prevalence of scoliosis and musculoskeletal asymmetries in adolescents with esophageal atresia. J Pediatr Surg 2023; 58 (03) 412-419
- 2 Mishra PR, Tinawi GK, Stringer MD. Scoliosis after thoracotomy repair of esophageal atresia: a systematic review. Pediatr Surg Int 2020; 36 (07) 755-761
- 3 Muensterer OJ, Sterlin A, Oetzmann von Sochaczewski C. et al. An experimental study on magnetic esophageal compression anastomosis in piglets. J Pediatr Surg 2020; 55 (03) 425-432
- 4 Sterlin A, Evans L, Mahler S. et al. An experimental study on long term outcomes after magnetic esophageal compression anastomosis in piglets. J Pediatr Surg 2022; 57 (01) 34-40
- 5 Muensterer OJ, Evans LL, Sterlin A. et al. Novel device for endoluminal esophageal atresia repair: first-in-human experience. Pediatrics 2021; 148 (05) e2020049627
- 6 Evans LL, Chen CS, Muensterer OJ. et al. The novel application of an emerging device for salvage of primary repair in high-risk complex esophageal atresia. J Pediatr Surg 2022; 57 (12) 810-818
- 7 Holler AS, König TT, Chen C, Harrison MR, Muensterer OJ. Esophageal magnetic compression anastomosis in esophageal atresia repair: a PRISMA-compliant systematic review and comparison with a novel approach. Children (Basel) 2022; 9 (08) 1113 DOI: 10.3390/children9081113.
- 8 Seleim HM, Wishahy AMK, Magdy B. et al. The dilemma after an unforeseen aortic arch anomalies at thoracoscopic repair of esophageal atresia: Is curtailing surgery still a necessity?. Scand J Surg 2022 ;111(2):14574969221090487
- 9 Berthet S, Tenisch E, Miron MC. et al. Vascular anomalies associated with esophageal atresia and tracheoesophageal fistula. J Pediatr 2015; 166 (05) 1140-1144.e2
- 10 Ghezzi M, D'Auria E, Farolfi A. et al. Airway malacia: clinical features and surgical related issues, a ten-year experience from a tertiary pediatric hospital. Children (Basel) 2021; 8 (07) 613
- 11 Jones DW, Kunisaki SM, Teitelbaum DH, Spigland NA, Coran AG. Congenital esophageal stenosis: the differential diagnosis and management. Pediatr Surg Int 2010; 26 (05) 547-551
- 12 Markel M, Derraugh G, Lacher M. et al. Musculoskeletal deformities in children with congenital thoracic malformations: a population-based cohort study. Pediatr Surg Int 2022; 38 (05) 731-736