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Oral Presentation - 39
Tracheostomies for infants with esophageal atresia with/without tracheoesophageal fistula (EA/TEF)- a Canadian multi-centre study.
P Chiu*, E Lapidus-Krol**, E Propst*, N Wolter*, J Siu*, P Campisi*, O Honjo*, E St-Louis***, J Laberge***, K Jeong****, R Baird****, A Aspirot*****, S Laberge******, C Faure******
*The Hospital for SIck Children and University of Toronto
**The Hospital for Sick Children
***Montreal Children's Hospital, McGill University
****BC Children's Hospital, University of British Columbia
*****Sainte-Justine Hospital, University of Montreal
******Department of Pediatric Gastroenterology, Sainte-Justine Hospital, Montreal, Quebec, Canada; Université de Montréal, Montréal, QC, Canada
Background: Infants with esophageal atresia with or without tracheoesophageal fistula (EA/TEF) may encounter life-threatening airway complications. Tracheostomy is used if other interventions are ineffective. This multi-centre review assessed the use of tracheostomies among EA/TEF patients.
Methods: An REB approved multi-centre retrospective chart review of EA/TEF patients repaired from Jan. 1, 2000 to Nov. 30, 2024 was performed. Indications for tracheostomy and prior surgical efforts to manage airway complications were obtained.
Results: In total, over 781 EA/TEF patients were included. Of these, 7 patients required tracheostomy for their airway complications. Two long gap EA patients had airway obstruction from tracheomalacia (TM) requiring tracheostomy- one at age 4.8 months after failed airway pexies, the second required tracheostomy at age 4 months without prior airway pexy. Three patients had tracheostomies for vocal cord (VC) paralysis- one had tracheostomy at age 5.9 months and subsequently decannulated at age 3 years, the second had bilateral VC paralysis, anastomotic stricture and severe TM while the third required tracheostomy at age 10 months after failed airway pexy in the setting of VC paralysis and CHARGE syndrome. The latter 2 patients have not yet been decannulated. One patient who was prenatally diagnosed with micrognathia due to Pierre-Robin sequence had tracheostomy at birth, was subsequently found to have EA/TEF and remains with the airway at the time of transition to adult care. One patient with type 3 laryngeal cleft had tracheostomy at age 2.6 months prior to EA/TEF repair to manage airway secretions safely. This patient remains with the airway while undergoing further operative procedures for VACTERL associated anomalies.
Conclusion: Tracheostomy for definitive airway management is rare among EA/TEF patients. Indications include associated congenital abnormalities or progressive conditions (TM, VC paralysis). Tracheostomy may be unavoidable for a subset of EA/TEF patients who encounter airway complications refractory to other interventions.