Skip to main content
SpringerLink
Log in

Preoperative laryngotracheobronchoscopy in infants with esophageal atresia: why is it not routine?

  • Review Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

The value of laryngotracheobronchoscopy (LTB) immediately prior to repair of esophageal atresia with or without tracheo-esophageal fistula is contentious. Currently, there is a wide range of opinion on the utility of this investigation which is reflected by huge variation in clinical practice. This review is a critical analysis of the arguments for and against performing routine LTB prior to esophageal atresia repair. Reserving LTB for selected cases only is potentially disadvantageous since it limits the surgeon’s and anesthetist’s familiarity with the procedure, equipment, and range of potential findings. There is sufficient evidence to suggest that routine preoperative LTB becomes the standard of care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lal D, Miyano G, Juang D, Sharp NE, St. Peter SD (2013) Current patterns of practice and technique in the repair of esophageal atresia and tracheoesophageal fistua: an IPEG survey. J Laparoendosc Adv Surg Tech 23(7):635–638

    Article  Google Scholar 

  2. Zani A, Eaton S, Hoellwarth ME, Puri P, Tovar J, Fasching G, Bagolan P, Lukac M, Wijnen R, Kuebler JF (2014) International survey on the management of esophageal atresia. Eur J Pediatr Surg 24(01):003–008

    Article  Google Scholar 

  3. Sfeir R, Bonnard A, Khen-Dunlop N, Auber F, Gelas T, Michaud L, Podevin G, Breton A, Fouquet V, Piolat C (2013) Esophageal atresia: data from a national cohort. J Pediatr Surg 48(8):1664–1669

    Article  PubMed  Google Scholar 

  4. Lal DR, Gadepalli SK, Downard CD, Ostlie DJ, Minneci PC, Swedler RM, Chelius T, Cassidy L, Rapp CT, Deans KJ (2017) Perioperative management and outcomes of esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 52(8):1245–1251

    Article  PubMed  Google Scholar 

  5. Knottenbelt G, Costi D, Stephens P, Beringer R, Davidson A (2012) An audit of anesthetic management and complications of tracheo-esophageal fistula and esophageal atresia repair. Pediatric Anesthesia 22(3):268–274

    Article  PubMed  Google Scholar 

  6. Beasley S, Shann F, Myers N, Auldist A (1989) Developments in the management of oesophageal atresia and tracheo-oesophageal fistulas. Med J Aust 150(9):501–503

    CAS  PubMed  Google Scholar 

  7. Engum SA, Grosfeld JL, West KW, Rescorla FJ, Scherer LT (1995) Analysis of morbidity and mortality in 227 cases of esophageal atresia and/or tracheoesophageal fistula over two decades. Arch Surg 130(5):502–508

    Article  CAS  PubMed  Google Scholar 

  8. Louhimo I, Lindahl H (1983) Esophageal atresia: primary results of 500 consecutively treated patients. J Pediatr Surg 18(3):217–229

    Article  CAS  PubMed  Google Scholar 

  9. Manning PB, Morgan RA, Coran AG, Wesley JR, Polley TZ Jr, Behrendt DM, Kirsh MM, Sloan HE (1986) Fifty years’ experience with esophageal atresia and tracheoesophageal fistula. Beginning with Cameron Haight’s first operation in 1935. Ann Surg 204(4):446

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Randolph JG (1986) Esophageal atresia and congenital stenosis - Esophageal atresia and associated malformations, including laryngotracheoesophageal cleft. In: Welch, Mea (eds) Pediatric surgery, vol 1, 4th edn. Year Book Medical, Chicago, pp 682–684

    Google Scholar 

  11. Spitz L, Kiely E, Morecroft J, Drake D (1994) Oesophageal atresia: at-risk groups for the 1990s. J Pediatr Surg 29(6):723–725

    Article  CAS  PubMed  Google Scholar 

  12. Spitz L (2006) Esophageal atresia: lessons I have learned in a 40-year experience. J Pediatr Surg 41(10):1635–1640

    Article  PubMed  Google Scholar 

  13. Chiou E, Ongkasuwan J (2014) Delayed identification of proximal tracheoesophageal fistula. J Pediatr Gastroenterol Nutr 58(5):e45

    Article  PubMed  Google Scholar 

  14. Holzki J (1992) Bronchoscopic findings and treatment in congenital tracheo-oesophageal fistula. Paediatr Anaesth 2(4):297–303

    Article  Google Scholar 

  15. Dudgeon DL, Morrison CW, Woolley MM (1972) Congenital proximal tracheoesophageal fistula. J Pediatr Surg 7(5):614–619

    Article  CAS  PubMed  Google Scholar 

  16. Sharma N, Srinivas M (2014) Laryngotracheobronchoscopy prior to esophageal atresia and tracheoesophageal fistula repair—its use and importance. J Pediatr Surg 49(2):367–369

    Article  PubMed  Google Scholar 

  17. Pigna A, Gentili A, Landuzzi V, Lima M, Baroncini S (2001) Bronchoscopy in newborns with esophageal atresia. Pediatr Med Chir 24(4):297–301

    Google Scholar 

  18. Atzori P, Iacobelli BD, Bottero S, Spirydakis J, Laviani R, Trucchi A, Braguglia A, Bagolan P (2006) Preoperative tracheobronchoscopy in newborns with esophageal atresia: does it matter? J Pediatr Surg 41(6):1054–1057

    Article  PubMed  Google Scholar 

  19. Bax KNM, Roskott AMC, van der Zee DC (2008) Esophageal atresia without distal tracheoesophageal fistula: high incidence of proximal fistula. J Pediatr Surg 43(3):522–525

    Article  PubMed  Google Scholar 

  20. Parolini F, Morandi A, Macchini F, Canazza L, Torricelli M, Zanini A, Leva E (2013) Esophageal atresia with proximal tracheoesophageal fistula: a missed diagnosis. J Pediatr Surg 48(6):e13–e17

    Article  PubMed  Google Scholar 

  21. Shoshany G, Vatzian A, Ilivitzki A, Smolkin T, Hakim F, Makhoul IR (2009) Near-missed upper tracheoesophageal fistula in esophageal atresia. Eur J Pediatr 168(10):1281–1284

    Article  PubMed  Google Scholar 

  22. Summerour V, Stevens PS, Lander AD, Singh M, Soccorso G, Arul GS (2017) Characterization of the upper pouch tracheo–oesophageal fistula in oesophageal atresia. J Pediatr Surg 52(2):231–234

    Article  PubMed  Google Scholar 

  23. Goh D, Brereton R, Spitz L (1991) Esophageal atresia with obstructed tracheoesophageal fistula and gasless abdomen. J Pediatr Surg 26(2):160–162

    Article  CAS  PubMed  Google Scholar 

  24. Kluth D (1976) Atlas of esophageal atresia. J Pediatr Surg 11(6):901–919

    Article  CAS  PubMed  Google Scholar 

  25. Filston H, Rankin J, Grimm J (1984) Prognostic factors and contribution of preoperative telescopic endoscopy. Esophageal atresia. Ann Surg 199:532–536

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Kosloske AM, Jewell PF, Cartwright KC (1988) Crucial bronchoscopic findings in esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 23(5):466–470

    Article  CAS  PubMed  Google Scholar 

  27. Alabbad SI, Shaw K, Puligandla PS, Carranza R, Bernard C, Laberge J-M (2009) The pitfalls of endotracheal intubation beyond the fistula in babies with type C esophageal atresia. Semin Pediatr Surg 18(2):116–118

    Article  PubMed  Google Scholar 

  28. Holcomb GW (2017) Thoracoscopic surgery for esophageal atresia. Pediatr Surg Int 33(4):475–481

    Article  PubMed  Google Scholar 

  29. Broemling N, Campbell F (2011) Anesthetic management of congenital tracheoesophageal fistula. Pediatr Anesthesia 21(11):1092–1099

    Article  Google Scholar 

  30. Andropoulos D, Rowe R, Betts J (1998) Anaesthetic and surgical airway management during tracheo-oesophageal fistula repair. Pediatr Anesthesia 8(4):313–319

    Article  CAS  Google Scholar 

  31. Krasna IH, Rosenfeld D, Benjamin BG, Klein G, Hiatt M, Hegyi T (1987) Esophageal perforation in the neonate: an emerging problem in the newborn nursery. J Pediatr Surg 22(8):784–790

    Article  CAS  PubMed  Google Scholar 

  32. Blair G, Filler R, Theodorescu D (1987) Neonatal pharyngoesophageal perforation mimicking esophageal atresia: clues to diagnosis. J Pediatr Surg 22(8):770–774

    Article  CAS  PubMed  Google Scholar 

  33. Kassner E, Baumstark A, Balsam D, Haller J (1977) Passage of feeding catheters into the pleural space: a radiographic sign of trauma to the pharynx and esophagus in the newborn. Am J Roentgenol 128(1):19–22

    Article  CAS  Google Scholar 

  34. Kane TD, Atri P, Potoka DA (2007) Triple fistula: management of a double tracheoesophageal fistula with a third H-type proximal fistula. J Pediatr Surg 42(6):e1-e3

    Article  Google Scholar 

  35. Spitz L, Kiely E, Brereton R (1987) Esophageal atresia: five year experience with 148 cases. J Pediatr Surg 22(2):103–108

    Article  CAS  PubMed  Google Scholar 

  36. Hseu A, Recko T, Jennings R, Nuss R (2015) Upper airway anomalies in congenital tracheoesophageal fistula and esophageal atresia patients. Ann Otol Rhinol Laryngol 124(10):808–813

    Article  PubMed  Google Scholar 

  37. Fraga JC, Adil EA, Kacprowicz A, Skinner ML, Jennings R, Lillehei C, Rahbar R (2015) The association between laryngeal cleft and tracheoesophageal fistula: myth or reality? Laryngoscope 125(2):469–474

    Article  PubMed  Google Scholar 

  38. Alfery DD, Ward C, Plumer MH, Lynch F (1980) Management of tracheal atresia with tracheoesophageal fistula. J Am Soc Anesthesiol 53(3):242–243

    Article  CAS  Google Scholar 

  39. Bray R, Lamb W (1988) Tracheal stenosis or agenesis in association with tracheo-oesophageal fistula and oesophageal atresia. Anaesthesia 43(8):654–658

    Article  CAS  PubMed  Google Scholar 

  40. Loeff D, Filler R, Vinograd I, Ein S, Williams W, Smith C, Bahoric A (1988) Congenital tracheal stenosis: a review of 22 patients from 1965 to 1987. J Pediatr Surg 23(8):744–748

    Article  CAS  PubMed  Google Scholar 

  41. Wailoo M, Emery J (1979) The trachea in children with tracheo-oesophageal fistula. Histopathology 3(4):329–338

    Article  CAS  PubMed  Google Scholar 

  42. Benjamin B (1981) Endoscopy in esophageal atresia and tracheoesophageal fistula. Annals of Otology. Rhinol Laryngol 90(4):376–382

    Article  CAS  Google Scholar 

  43. Dodge-Khatami A, Deanovic D, Sacher P, Weiss M, Gerber A (2006) Clinically relevant tracheomalacia after repair of esophageal atresia: the role of minimal intra-operative dissection and timing for aortopexy. Thorac Cardiovasc Surg 54(03):178–181

    Article  CAS  PubMed  Google Scholar 

  44. Mortellaro V, Pettiford J, St Peter S, Fraser J, Ho B, Wei J (2011) Incidence, diagnosis, and outcomes of vocal fold immobility after esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) repair. Eur J Pediatr Surg 21(06):386–388

    Article  CAS  PubMed  Google Scholar 

  45. Morini F, Iacobelli BD, Crocoli A, Bottero S, Trozzi M, Conforti A, Bagolan P (2011) Symptomatic vocal cord paresis/paralysis in infants operated on for esophageal atresia and/or tracheo-esophageal fistula. J Pediatr 158(6):973–976

    Article  PubMed  Google Scholar 

  46. Woo S, Lau S, Yoo E, Shaul D, Sydorak R (2015) Thoracoscopic versus open repair of tracheoesophageal fistulas and rates of vocal cord paresis. J Pediatr Surg 50(12):2016–2018

    Article  PubMed  Google Scholar 

  47. Qi BQ, Merei J, Farmer P, Hasthorpe S, Myers NA, Beasley SW, Hutson JM (1997) The vagus and recurrent laryngeal nerves in the rodent experimental model of esophageal atresia. J Pediatr Surg 32(11):1580–1586

    Article  CAS  PubMed  Google Scholar 

  48. De Gabriele L, Cooper M, Singh S, Pitkin J (2001) Intraoperative fibreoptic bronchoscopy during neonatal tracheo-oesophageal fistula ligation and oesophageal atresia repair. Anaesth Intensive Care 29(3):284

    PubMed  Google Scholar 

  49. Parolini F, Boroni G, Stefini S, Agapiti C, Bazzana T, Alberti D (2014) Role of preoperative tracheobronchoscopy in newborns with esophageal atresia: A review. World J Gastrointest Endosc 6(10):482

    Article  PubMed  PubMed Central  Google Scholar 

  50. Veyckemans F, Hamoir M, Rombaux P, Van Obbergh LJ, Reding R (2002) Preoperative tracheoscopy in neonates with esophageal atresia. Anesthesia Analgesia 95(6):1827–1828

    Article  PubMed  Google Scholar 

  51. Midulla F, De Blic J, Barbato A, Bush A, Eber E, Kotecha S, Haxby E, Moretti C, Pohunek P, Ratjen F (2003) Flexible endoscopy of paediatric airways. Eur Respir J 22(4):698–708

    Article  CAS  PubMed  Google Scholar 

  52. Nussbaum E (2002) Pediatric fiberoptic bronchoscopy: clinical experience with 2,836 bronchoscopies. Pediatr Crit Care Med 3(2):171–176

    Article  PubMed  Google Scholar 

  53. Deanovic D, Gerber AC, Dodge-Khatami A, Dillier CM, Meuli M, Weiss M (2007) Tracheoscopy assisted repair of tracheo-esophageal fistula (TARTEF): a 10-year experience. Pediatr Anesthesia 17(6):557–562

    Article  Google Scholar 

  54. De Blic J, Marchac V, Scheinmann P (2002) Complications of flexible bronchoscopy in children: prospective study of 1,328 procedures. Eur Respir J 20(5):1271–1276

    Article  PubMed  Google Scholar 

  55. Templeton JM, Templeton JJ, Schnaufer L, Bishop HC, Ziegler MM, O’Neill JA (1985) Management of esophageal atresia and tracheoesophageal fistula in the neonate with severe respiratory distress syndrome. J Pediatr Surg 20(4):394–397

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Paediatric Surgery, Starship Children’s Hospital, Auckland, New Zealand

    Kiarash Taghavi

  2. Department of Surgery, University of Auckland, Auckland, New Zealand

    Kiarash Taghavi

  3. Department of Paediatric Surgery, Wellington Children’s Hospital, Riddiford Street, Newtown, Wellington, 6021, New Zealand

    Mark D. Stringer

  4. Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand

    Mark D. Stringer

Authors
  1. Kiarash Taghavi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark D. Stringer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark D. Stringer.

Ethics declarations

Conflict of interest

The authors declare that there is no competing interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Taghavi, K., Stringer, M.D. Preoperative laryngotracheobronchoscopy in infants with esophageal atresia: why is it not routine?. Pediatr Surg Int 34, 3–7 (2018). https://doi.org/10.1007/s00383-017-4194-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-017-4194-0

Keywords

Search

Navigation