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Laryngotracheoesophageal cleft (type IV): management and repair of lesions beyond the carina.

Abstract：

:Since the first successful repair of a complete laryngotracheoesophageal cleft (LTEC) to the carina in 1982, three newborn infants were observed with a particularly difficult variant in which the cleft extends beyond the carina into the mainstem bronchi. This type IV LTEC creates a long common tracheoesophagus, whose successful separation requires meticulous preoperative, operative, and postsurgical care. Three infants had complete surgical repair at our institution at 29, 49, and 225 days old and survived a minimum of 8 months. Recurrent tracheoesophageal fistulae at the thoracic inlet occurred in two infants, but was not observed in one patient when sternocleidomastoid muscle was interposed between the trachea and esophagus in the neck. Microgastria is an associated finding in each infant with the tracheoesophageal cleft extending beyond the carina. The small stomach is problematic as it is anatomically inadequate for any antireflux procedure and has not grown well, even with prolonged feeding. Early cleft repair is essential to prevent the development of chronic lung disease secondary to recurrent aspiration. The techniques to make the diagnosis, the preferred treatment to initially protect the airway, a single-stage operation performed simultaneously through the chest and neck to definitively repair the cleft, and finally the intraoperative and postoperative management critical for an optimal outcome are described.

journal_name

J Pediatr Surg

journal_title

Journal of pediatric surgery

authors

Ryan DP,Muehrcke DD,Doody DP,Kim SH,Donahoe PK

doi

10.1016/0022-3468(91)90844-j

subject

Has Abstract

pub_date

1991-08-01 00:00:00

pages

962-9; discussion 969-70

issue

8

eissn

0022-3468

issn

1531-5037

pii

0022-3468(91)90844-J

journal_volume

26

pub_type

杂志文章

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