Lower esophageal banding in extremely low birth weight infants with esophageal atresia and tracheoesophageal fistula is a life saving practice followed by a successful delayed primary thoracoscopy reconstruction.

In extremely low birth weight (ELBW) infants, i.e. <1000g, with esophageal atresia (EA) and tracheoesophageal fistula (TEF), surgical treatment is a real challenge. High morbidity is associated with primary repair of EA on these patients. We report our recent experience with three cases of ELBW infants with EA and TEF treated by lower esophageal banding (LEB). From September 2012 to January 2013, three ELBW infants with EA/TEF were born prematurely with severe respiratory distress. One of them had VACTER association with anorectal malformation (ARM). The gestational age was between 25 and 27weeks, and the mean birth weight was 690g (500-790). All were treated by LEB and gastrostomy, followed by delayed primary thoracoscopy reconstruction. One baby died in the postoperative period because of intraventricular hemorrhage at 7days after initial surgery. Among the 2 others cases, one of them required ligation without section of the TEF with removal of LEB by thoracoscopy at 30days old and 1300g. Delayed primary thoracoscopy reconstruction and section of TEF were performed by thoracoscopy at 70 and 80days old and 2100g and 2200g respectively without early complication. The follow-up was 12months. One baby presented a stenosis requiring one dilation of lower esophagus with uneventful course. LEB is a life saving practice in ELBW babies with EA and TEF. The esophagus can tolerate the ligation even with a thread without having a long time major complication. Thoracoscopic reconstruction of the esophagus is possible in these babies.

Margain L ，Perez-Etchepare E ，Varlet F ，Lopez M ... -  《-》

Outcome of esophageal atresia/tracheoesophageal fistula in extremely low birth weight neonates (<1000 grams).

Zani A ，Wolinska J ，Cobellis G ，Chiu PP ，Pierro A ... -  《-》

Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula: a multi-institutional analysis.

Holcomb GW 3rd ，Rothenberg SS ，Bax KM ，Martinez-Ferro M ，Albanese CT ，Ostlie DJ ，van Der Zee DC ，Yeung CK ... -  《-》

Postoperative Complications and Functional Outcome after Esophageal Atresia Repair: Results from Longitudinal Single-Center Follow-Up.

Friedmacher F ，Kroneis B ，Huber-Zeyringer A ，Schober P ，Till H ，Sauer H ，Höllwarth ME ... -  《-》

Outcome of primary repair in extremely and very low-birth-weight infants with esophageal atresia/distal tracheoesophageal fistula.

The optimal surgical management of extremely (ELBW) and very low-birth-weight (VLBW) neonates with esophageal atresia and distal tracheoesophageal fistula (EA/TEF) (Gross type C) is still debated. The aim of this study was to evaluate the surgical outcome of primary repair in these patients and compare it to ≥1500g neonates. Medical records of neonates with repaired EA from 2002 to 2016 were reviewed. 4 ELBW, 7 VLBW, and 24 ≥1500g infants had type C EA/TEF and underwent primary repair. Anastomotic leakage occurred in 0% ELBW, 0% VLBW and 8.3% ≥1500g patients and anastomotic stricture in 25% ELBW, 28.5% VLBW and 37.5% ≥1500g patients. 50% ELBW, 14.2% VLBW and 20.8% ≥1500g patients underwent secondary fundoplication. One patient of the VLBW group and one patient of the ≥1500g group died postoperatively of causes not related to EA/TEF. In extremely and very low-birth-weight neonates with type C EA/TEF surgical outcome after primary repair is comparable to the outcome in ≥1500g neonates. Primary repair can be performed in most of these patients and staged repair can be restricted to unstable patients. Treatment study level III.

Schmidt A ，Obermayr F ，Lieber J ，Gille C ，Fideler F ，Fuchs J ... -  《-》