Preoperative tracheobronchoscopy in newborns with esophageal atresia: does it matter?
OBJECTIVE
Despite surgical refinements, perioperative use of tracheobronchoscopy (TBS) as part of surgical approach to esophageal atresia (EA) is still controversial. The purpose of this study was to evaluate the influence of preoperative TBS in newborns with EA in preventing complications and improving diagnosis and surgical treatment.


METHODS
In the period ranging from 1997 to 2003, 62 patients with EA underwent preoperative TBS. The procedure was carried out with flexible bronchoscope maintaining spontaneous breathing. When a wide carinal fistula was found, this was mechanically occluded by Fogarty catheter and cannulated with rigid bronchoscopy. Type of EA, surgical procedure variations caused by TBS, and associated anomalies not easily detectable were recorded.


RESULTS
Before TBS, the Gross classification of the 62 patients was as follows: type A, 9 patients; type B, none; type C, 51 patients. At TBS, however, 3 of 9 type A patients had an unsuspected proximal fistula (type B). These 3 patients, plus the 2 with H-type fistula, were repaired through a cervical approach. In 4 patients, previously undetected malformations of the respiratory tree (2 aberrant right upper bronchus and 2 hypoplastic bronchi) were found at TBS. Carinal fistulas in 14 type C patients were occluded by Fogarty catheter to improve ventilation during repair. No complications were observed. Overall, TBS was clinically useful in 28 (45.2%) of 62 patients, including 15 (24.2%) of 62 infants in whom it was crucial in modifying the surgical approach.


CONCLUSIONS
Tracheobronchoscopy is a useful and safe procedure and should be recommended in tertiary centers for babies with EA before surgical repair.
Atzori
Pietro
P
Neonatal Surgery Unit-Department of Medical and Surgical Neonatology, Bambino Gesù Childrens' Hospital, Rome-00165 Italy. pietroatzori@tiscali.it
Iacobelli
Barbara D
BD
Bottero
Sergio
S
Spirydakis
Joannis
J
Laviani
Raoul
R
Trucchi
Alessandro
A
Braguglia
Annabella
A
Bagolan
Pietro
P
D001999:Bronchoscopy / Q000592:standards; D013505:Digestive System Surgical Procedures; D004724:Endoscopy / Q000592:standards; D004933:Esophageal Atresia / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D016156:Respiratory Tract Fistula / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D014132:Trachea / Q000473:pathology*