الفهرس 
Introduction and Aim of the workOnly 14 pages are availabe for public view
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Abstract
Esophageal atresia presents some of the greatest technical hurdles that the pediatric surgeon has to face. Little more than 60 years ago esophageal atresia was considered a uniformly fatal condition. Now, survival is almost guaranteed and determined by associated abnormalities rather than the esophageal atresia itself.
The focus of attention has shifted from survival to minimization of morbidity. Nevertheless, with all its variations, subtleties, technical difficulties, and the long-term implications, esophageal atresia continues to challenge the pediatric surgeon.
Congenital atresia of the esophagus and tracheoesophageal fistula (TEF) occur in one of every 3,500 to 4,500 live births. Treatment of esophageal atresia (EA) and TEF is a success story of modern medicine. First described in the 1600s, this condition was universally fatal until the mid-1900s. After repeated failures, surgical pioneers including Ladd, Leven and Haight persisted and improved their anatomic knowledge. Their persistence paid off, allowing them to develop new surgical techniques that led to the first EA and TEF survivors. Today, further advancements in neonatal intensive care, surgery, anesthesiology, and parenteral nutrition have improved survival to greater than 90 percent.
Anatomic Classifications
Six types of esophageal atresia have been described. Vogt and Gross initially created nomenclature to describe the types of atresia; however, the more accepted classification is to describe the atresia based on anatomic abnormality.. The most common type of EA is with a distal TEF.
Associated Anomalies
The association between EA and other congenital anomalies is well known. The most common association is described by the acronym VACTERL and includes: anomalies of the vertebrae (similar to those of spondylocostal dysplasia); intestinal atresia; cardiac malformations (patent ductus arteriosus, atrial septal defect, or ventricular septal defect); tracheoesophageal fistula; renal anomalies (urethral atresia with hydronephrosis); and limb anomalies (hexadactyly, humeral hypoplasia, radial aplasia, and proximally placed thumb).
Aim of study:
We discuss the difficulties and challenges in the management of EA/ TEF . Including diagnosis, preoperative measures, operative techniques, post operative complication and long term follow up.
Diagnosis
1- antenatal diagnosis: Polyhydramnios is present in 50 percent of mothers carrying infants with esophageal atresia. Other antenatal ultrasound findings include microgastria and/or a distended upper esophageal pouch.
2-postnata diagnosis: the presence of excessive drooling or aspiration and coughing with feeds must lead to an evaluation for EA. Confirmation of the diagnosis can be made by attempting to pass a 10 French orogastric tube into the stomach and meeting resistance.
3-late and rare presentation of TEF: with H type in adult due to minute symptoms in some patient,low indix of suspicion by the physicion, and unsatisfactory radiological methods.
4-Silent TEF:intra operative diagnosis of TEF in asymptomatic child. While under the effect of general anaesthesia using adequately fitting endotracheal tube(ETT) and muscle relaxant,during intermittent positive pressure ventilation(IPPV) abnormal bloating of the stomach will be notice
Preoperative measures
1-search for associated anomalies is required. Prior to performing operative repair
a- Echocardiography should be performed for two reasons. The first is to rule out cyanotic congenital heart anomalies that may require immediate repair. Secondly, it is necessary to determine if the aortic arch is left or right sided. In patients witha left-sided aortic arch, a routine right thoracotomy is performed for repair of the EA.
However, in the rare instance (2 percent) of patients with a right-sided arch, a left thoracotomy is required.
b-Other necessary studies include a babygram (full body X-ray) to evaluate for vertebral anomalies, and a renal ultrasound. Spinal ultrasound or MRI for tethered cord, and a voiding cystourethrogram should be performed prior to discharge to complete the VACTERL evaluation.
2-look for other prognostic factores including:
a-low birth weight:Initiate early prenatal nutrition through a centeral venous catheter. It is recommended note to place the catheter in the left of the neck in cases there is the possibilityto perform an esophagostomy
b-pneumonia:double antibiotic scheam(ampicillin plus aminoglucosides),
c-Extreme prematurity :there is risk of developing hyaline membrane disease during the first 24 h after birth. gas tends to pass preferentially through the distal tracheoesophageal fistula causing gastric distention and perforation.