It's hard to believe that this smiling baby was born with a birth defect incompatible with life. If it weren’t for the highly competent doctors, she would have lived only a few hours. The expectant mother learned that her baby had a digestive anomaly during pregnancy. Doctors discovered esophageal atresia in the fetus, which meant that gastrostomy had to be done immediately after birth to deliver milk to the stomach, since the newborn would not be able to eat on her own.
With its state-of-the-art equipment and experienced doctors, the Perinatal Centre of Almazov Centre is able to successfully help children with various disorders. Therefore, the woman chose to give birth in this clinic. After the birth, the examination showed that the newborn girl had a very rare form of atresia, without fistula, accounting for about 5% of all atresia cases. Esophageal atresia is a severe congenital malformation in which the upper and lower segments of the esophagus are separated and either end in blind pouches or communicate with the trachea. In atresia without fistula, the lower esophagus is very small and not attached to anything. In fact, the two ends of the esophagus are not connected to each other, and the distance between them is sometimes so great that it is impossible to pull them together. In this patient, the gap was 5 thoracic vertebrae.
Previously, most children with esophageal atresia had to undergo retrosternal esophageal replacement using colon graft. At the age of 6 months to 1 year, they had a surgery in which the two ends of the esophagus were connected using a part of the large intestine. However, this cannot fully replace the missing portion of the esophagus, because the intestinal tissues are not adapted to move food. This often leads to serious digestive problems.
It is very difficult and, in some cases, almost impossible to save the esophagus by connecting its ends rather than using part of the intestine, since the distance between them is so large that the esophagus can tear when stretched. A method for this purpose has appeared relatively recently with the advent of high technology and endoscopic procedures. With this, surgeons began to perform several minimally invasive interventions when small segments of the esophagus are isolated and brought together as far as possible. The interval between procedures is about a week. After 6 to 7 days, engraftment of these segments is observed, and they can be brought closer together. After that, it is already possible to connect them together – to create an anastomosis. Surgeons managed to do this in two interventions in this little patient.
“Unfortunately, the staged connection method is not always successful, but if it works, it gives the patient a chance for a healthy full life in the future,” explains Dr. Ilya Kagantsov, pediatric surgeon and Head of Research Laboratory for Surgery of Congenital and Hereditary Diseases.
Of course, after surgical treatment, such children remain under the close supervision of doctors who help regulate the normal functioning of the esophagus.
“One of the terrible complications of a surgical intervention with a staged connection of the ends of the esophagus is when scar tissue is formed at the site of the anastomosis. It prevents food from moving, and esophageal bougienage has to be performed to dilate the esophagus. At the same time, as babies