Tuesday, August 28, 2012

History of EA/TEF

Hello Christy's Courage Crew!

I have been wondering about when the first actual diagnosis of EA/TEF was discovered and found this piece of information about the History of the Procedure. 

The recorded history of EA dates back as early as 1670 when Durston described the presence of a blind-ending upper esophageal pouch in a conjoined twin; however, surgical therapy for EA was not suggested until 1869. Steele made the first attempt at surgical correction for EA in 1888. He performed a gastrostomy in a patient with pure EA, hoping to perforate what he suspected to be an esophageal membrane. In 1913, Richter proposed fistula ligation with anastomosis of the 2 esophageal ends for EA with TEF. Although he considered primary repair to be the best option, he also acknowledged the impracticality of this procedure at the time. Instead, he ligated the fistula intrathoracically. His patient did not survive long enough to attempt an esophageal anastomosis.
The first patient to survive a congenital esophageal anomaly was born in 1931 with a TEF and no atresia. The fistula was repaired with a transtracheal incision in 1935, the same year that the first survivor of EA was born. The infant with EA was treated with gastrostomy feedings and a jejunal interposition. Both of these children had an isolated defect (atresia or fistula), and treatment was successful without a thoracotomy. The treatment for EA with TEF proved to be more difficult. Pneumonia, mediastinitis, poor airway control, and fluid management problems were frequent complications.
In 1936, Lanman was the first to perform a repair with an extrapleural approach. The first patient to undergo the technique survived only 3 hours. In 1938, Shaw performed the first fistula ligation and primary anastomosis of the esophagus for EA-TEF. This patient died 12 days postoperatively from a transfusion reaction.
In 1939, the first 2 successful treatments of patients with EA-TEF occurred independently, one day apart, by Leven and Ladd. They performed staged repairs involving gastrostomy placement followed by fistula ligation 5 weeks and 4 months later, respectively. Cervical esophagostomies, the use of jejunal interposition, and an antethoracic skin tube for esophageal reconstruction were use in the years to follow.
Haight completed the first successful primary repair in 1941. The procedure involved a left extrapleural approach, fistula ligation, and a single-layer esophageal anastomosis. Haight later switched to a right extrapleural approach and modified his technique to a 2-layer telescoping anastomosis in an attempt to diminish leak risk.
By 1944, one third of the children with EA-TEF survived primary repair. Advances in preoperative preparation, antibiotic treatment, and intraoperative and postoperative management contributed to more favorable survival rates. Despite the increased success, leaks, strictures, and lower esophageal segment dysmotility were common postoperative problems.

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