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Esophageal replacement (ER) is indicated in patients with long gap esophageal atresia (LGEA) or failure of the primary anastomosis. Also, severe caustic or peptic strictures, resistant to conservative treatment with medication and dilations, may require an ER. Numerous techniques with different organs and routes have been described, all with satisfactory results.
Our objective is to describe the experience obtained with partial gastric pull-up according to the Schärli principles (SGPA).
Materials and Methods
Medical records of patients who required a SGPA between October 1995 to June 2018 were reviewed. The analysis was observational, longitudinal, retro-prospective and descriptive. Epidemiological data, surgical aspects and postoperative complications of the patients were considered.
Seventy ER were performed with SGPA. The indication was esophageal atresia (EA) in 58 cases (44 long gap and 14 failure of the anastomosis), 10 caustic strictures, one peptic stricture resistant to conservative treatment and the other due to a retained foreign body. The age of the ER was on average 2-years and 9-months. The route was: posterior mediastinal (35), retrosternal (29) and transpleural (6); without a thoracic approach in 59 patients. The duration of the procedure was 4.7-hours on average. There were 13 cases of intraoperative complications, 8 cases of pneumothorax, 5 bleeding injuries (3 in the spleen, 1 liver and 1 cervical), and one injury to the cervical trachea. Anastomotic dehiscence was observed in 37 patients (52%), which closed spontaneously after an average of 17.8-days in all except one patient. Thirty-one patients (44%) developed anastomotic stenosis, requiring redo anastomosis in 6 cases; 37% developed dumping and 23% gastroesophageal reflux disease. There were 3 deaths (4.2%): all in EA patients with associated malformations, following a morbid postoperative period with infectious complications in intensive care at 10-days, 7 and 8-months after ER. Follow-up was an average of 8-years. All 67 living patients are currently tolerating oral feeding.
In our experience with ER using SGPA, we observed a high incidence of complications, generating a longer post-operative evolution and with greater morbidity than that described in other techniques. Given these results, we changed our strategy to complete gastric transposition, in order to reduce morbidity and improve the evolution of this complex group of patients.
Esophageal replacement; Partial gastric pull-up; Esophageal atresia; Caustic stricture.
Congenital oesophageal atresia (COA) refers to a congenitally interrupted oesophagus. It is commonly referred to in the literature as oesophageal atresia (OA) with or without tracheo oesophageal fistula (TOF) but acquired TOF is a different entity.
We present a case of OA with TOF which was not suspected antenatally despite the presence of polyhydramnios. The baby presented with respiratory distress and excessive oral secretions at the age of 3-hours following initiation of breastfeeding. Thorascopic repair was performed on the second day of life. The pre-, intra- and post-operative course was smooth with no major challenges. There was no associated anomalies in our case following thorough systemic evaluation including brain ultrasound, abdominal ultrasound, skeletal survey, ophthalmic assessment and echocardiography.
This case demonstrates the importance of maintaining a high index of suspicion for OA when faced with a combination of respiratory distress and persistent frothy oral secretions in a newborn. The antenatal and postnatal diagnostic approaches are discussed with highlights of associated anomalies and pre-operative assessment and management
Congenital oesophageal atresia (COA); Tracheo oesophageal fistula (TOF); Oesophageal atresia (OA); Vertebral defects, anal atresia, cardiac defects, renal anomalies and limb abnormalities (VACTERL); Choanal atresia, retardation of growth, genital abnormalities,
and ear abnormalities (CHARGE).
Convulsion is an event that can emotionally traumatise most parents. Inadequate knowledge regarding convulsion can cause parental anxiety.
This research sought to investigate the knowledge, attitudes, concerns and practices of parents regarding convulsion in children under five-years.
The study employed a community based cross-sectional survey design. Purposive, convenient and snowball samplings were used to select the study site and enroll participants to the study. The study was conducted in Muea Community, Buea Health District in Fako Division, South West Region of Cameroon. The study participants were made up of parents of children under 5-years of age and who had witnessed convulsion in a child. Respondents who met the inclusion criteria and gave their consent to participate in the study were selected. Data was collected using a semi-structured questionnaire made up of both open and closed-ended questions. Data was collected on the knowledge, attitudes, concerns and practices of parents regarding convulsions in children. Data collected was entered using a pre-designed EpiData version 3.1 and data from open-ended questions were analysed using systematic process of thematic analysis.
A total of 100 respondents participated in the study. The study revealed that more than half of the respondents 53.7% had good knowledge on convulsion, 61.9% of the respondents had positive attitudes towards convulsion and 51.4% of parents had good practices regarding convulsion. This study also revealed that knowledge of convulsion had an association (p=0.05) with gender and marital status but was not dependent (p>0.05) on age and level of school attained.
The study concluded that even though more than half of the respondents were knowledgeable on convulsion, there is still need for proper parental education as inappropriate attitudes and practices like putting the child’s head in the toilet pit, which can lead to complications are still being practiced.
Knowledge; Convulsion; Attitudes; Concerns practices; Children under five; Parents.
Developmental disabilities (DDs) refer to a group of conditions that influence the early development of children and cause changes in their normal developmental pattern affecting their physical, language and mental abilities or behavior. Children with DDs just like normally developing children have health issues that need to be addressed. This special group of children especially those having autism frequently suffer from associated conditions such as gastrointestinal disorders, eating and feeding challenges, seizures, sleep disturbances, attention deficit and hyperactivity disorder, and anxiety among others. These health problems affect the health of these children in different ways and extent. Thus, children with DDs need to access healthcare services and receive quality medical care just like their normally developing peers. However, the health needs of children with DDs particularly autism are not being met as required even though this special population are more likely to seek medical care due to their disabilities and associated conditions. Children with autism and other DDs experience disparities in health and healthcare service utilization. Autism is linked to many health conditions such as epilepsy, gastrointestinal problems and other mental disorders. These health problems affect each individual with autism in a unique way negatively affecting his/her existing social interaction and communication impairments. Again, health facilities and medical equipment are not disability-friendly making it difficult for this special group to effectively have access to quality care. In addition, most healthcare providers do not possess adequate knowledge and skills required to make critical decisions regarding this very special group of persons. Furthermore, due to cultural differences certain diagnosis and treatment regarding autism and other developmental disabilities may not be welcomed. The public health sector of all nations has the duty to promote health and prevent diseases for all including persons with disabilities.
Developmental disabilities; Children with autism; Health conditions; Disparities in health;
Disparities in healthcare service utilization.
Associate Professor of Clinical Otolaryngology Department of Otolaryngology/DentistryNorthwestern University Feinberg School of MedicineAdjunct Professor Departments of Pediatric Dentistry, University of AlabamaBirmingham and Case Western Reserve University, Cleveland, USA
Professor Department of Pediatrics & OB/GYNSaint Louis University School of Medicine St. Louis, MO, USA