Magni, Ludovica (2024) Mind the Gap (again) - The fate of carinal fistulas in the treatment of esophageal atresia. thesis, Medicine.
Full text available on request.Abstract
Introduction: Esophageal atresia (EA) is a rare congenital defect often accompanied by a tracheoesophageal fistula (TEF) and requires surgical repair at birth. EA is classified by the Gross classification (1). Types A and B have a long gap between esophageal ends, leading to more complications, lower chances of preserving the native esophagus, and the need for specialized, multi-stage treatment (1,14). Type C, the most common form (84%), involves a distal TEF and is typically treated with primary anastomosis. A study showed that Type C with TEF at the carina (TEFC) - where the gap between pouches is large - resembles long-gap EA and has worse surgical outcomes compared to TEF above the carina and on the proximal trachea (TEFT) (9). We analyzed our experience with TEFC, hypothesizing that early primary anastomosis is equally feasible in TEFC and TEFT patients. Methods: We analyzed 25 TEFC and 109 TEFT patients treated thoracoscopically at the Wilhelmina Children’s Hospital, Utrecht from 2012 to 2024. The primary endpoints were the preservation of the native esophagus and incidence of postoperative anastomotic leakage, with secondary endpoints including short- and long-term surgical outcomes. Results: All 134 patients had a successful EA correction without requiring esophageal replacement surgery. However, TEFC patients experienced higher rates of anastomotic leakage (40% versus 20.2%), recurrent stenosis (24.0% versus 10.1%), and anti-reflux surgeries (26.1% versus 11.3%). Conclusion: TEFC cases were more complex and experienced more complications than TEFT, yet all patients preserved their native esophagus, advocating for treatment of TEFC in specialized centers.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Hulscher, Prof. Jan and Tytgat, Ass. Prof. Stefaan |
| Faculty: | Medical Sciences |
| Date Deposited: | 04 Nov 2025 13:47 |
| Last Modified: | 04 Nov 2025 13:47 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3845 |
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