Laryngotracheobronchoscopy prior to esophageal atresia and tracheoesophageal fistula repair--its use and importance

Abstract

Background: Pure esophageal atresia (EA) and esophageal atresia with tracheoesophageal fistula (EA-TEF) are commonly associated with various anomalies. Associated anomalies, especially those of upper airways may alter the management strategies. This study was designed to find out the role of preoperative laryngotracheobronchoscopy (LTB) just prior to the standard surgical procedure.

Study design: This was a retrospective study. The data of all the newborn babies (n=88) with a provisional diagnosis of EA or EA-TEF with preoperative rigid LTB, using 2.5/3.0/3.5F rigid bronchoscope were analyzed. This additional procedure entailed documenting the abnormalities, endoscopic lavage and noting the site of the fistula. The fistula was cannulated by 3.0 F ureteric catheter just prior to the standard surgical procedure. Management strategies were changed as per the additional findings.

Results: Out of 88 patients, 77 had EA-TEF while 11 had pure EA. LTB was performed in all of them. Additional findings in bronchoscopy were noted in 18 (20.46%) babies. These additional findings were: fistula at unusual site in 12, laryngotracheal cleft in 2 and vallecular cyst in 1 neonate. The diagnosis of pure EA turned out to be EA-TEF in 3 cases. Unusual fistula sites were carinal/subcarinal in 4/12 (33.33%), upper pouch fistula in 1/12 (8.33%), double fistula in 2/12 (16.67%) and fistula from main bronchus in 5/12 (41.67%) cases.

Conclusions: LTB performed just prior to the definitive surgical procedure in EA and EA-TEF would diagnose, document and may aid in the surgical management strategies.

Keywords: Bronchoscopy; Esophageal atresia; Laryngotracheobronchoscopy; Tracheoesophageal fistula.