Congenital laryngo-tracheo-esophageal clefts: updates from a quaternary care pediatric airway unit.

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Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_3216BF0B1A96
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Congenital laryngo-tracheo-esophageal clefts: updates from a quaternary care pediatric airway unit.
Journal
European archives of oto-rhino-laryngology
Author(s)
Ishii A., Christophel E., Chollet M., Sandu K.
ISSN
1434-4726 (Electronic)
ISSN-L
0937-4477
Publication state
Published
Issued date
01/2024
Peer-reviewed
Oui
Volume
281
Number
1
Pages
283-294
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
To review the operative techniques, outcomes, and complications following surgery in pediatric patients with laryngo-tracheo-esophageal clefts (LTEC). We describe a new combined approach to treat long LTECs.
Twenty-five patients underwent surgical repair for LTEC from March 2012 to July 2022 at our hospital. Every patient underwent a diagnostic endoscopy under general anesthesia and spontaneous ventilation to assess the LTEC and synchronous aero-digestive comorbidities/malformations. All patients underwent at least one surveillance endoscopy after the repair at our institution.
The patients had multiple other malformations, specifically gastro-intestinal, synchronous airway, and cardiac. The cleft distribution according to the modified Benjamin and Inglis classification was type I (n = 5, 20%), type II (n = 6, 24%), type IIIa (n = 8, 32%), type IIIb (n = 4, 16%), and type IVa (n = 2, 8%). The median follow-up was 44.6 months. Five patients (20%) had undergone previous cleft corrective surgery(s). Seven patients (28%) had partial to complete breakdown of the repair, needing additional intervention(s), and two required a combined-open plus endoscopic repair. Preoperatively, most patients (n = 18, 72%) needed a feeding assistance. At latest follow-up, feeding assistance was weaned off in 13 out of 18 patients, which was a 72% improvement. Ten patients (40%) needed ventilation assistance before the surgery. Post-operatively, ventilatory assistance was weaned off in 6 patients, meaning a 60% improvement.
LTEC are rare malformations, and their management needs precise diagnosis, appropriate surgical planning, and execution, and dedicated post-operative care. Primary and revision repair of long clefts with tracheal extension may require a combined approach.
Keywords
Humans, Child, Esophagus/surgery, Larynx/surgery, Trachea/surgery, Trachea/abnormalities, Abnormalities, Multiple/diagnosis, Respiratory System Abnormalities, Retrospective Studies, Endoscopic surgery, LTEC, Laryngo-tracheo-esophageal cleft, Open surgery
Pubmed
Web of science
Open Access
Yes
Create date
13/10/2023 9:45
Last modification date
08/08/2024 7:31
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