SURGICAL MANAGEMENT STRATEGIES FOR ESOPHAGEAL ATRESIA WITHOUT TRACHEOESOPHAGEAL FISTULA IN NEONATES

Аннотация

В данной статье рассматриваются особенности выбора хирургической тактики при врожденной атрезии пищевода без трахеопищеводного свища — одной из наиболее тяжелых форм патологии пищевода у новорожденных. Эта аномалия отличается сложной диагностикой, тяжелым течением и требует срочного оперативного вмешательства. В исследовании проанализированы различные клинические варианты заболевания, методы предоперационной диагностики, общее состояние пациентов и индивидуальные подходы к выбору хирургической тактики. Особое внимание уделено методам торакохирургии, применению малоинвазивных технологий, гастростомии, первичным и отсроченным анастомозам, а также ведению послеоперационного периода и отдаленным результатам. В заключении подчеркивается, что правильный выбор метода лечения значительно повышает шансы на выживание и улучшает качество жизни ребенка. Ключевые слова: Атрезия пищевода, трахеопищеводный свищ, чистая атрезия пищевода, неонатальная хирургия, врождённые аномалии пищевода, хирургическая тактика, торакальная хирургия, отсроченный анастомоз, первичный анастомоз, послеоперационный уход Esophageal atresia (EA) is a congenital anomaly characterized by an interruption in the continuity of the esophagus. It occurs in approximately 1 in 2,500 to 4,000 live births and represents one of the most critical conditions encountered in neonatal surgery. While the majority of cases (around 85–90%) are associated with a tracheoesophageal fistula (TEF), approximately 7–10% of patients present with isolated or "pure" esophageal atresia, where no communication exists between the esophagus and trachea. This rare variant is often associated with more complex clinical management, owing to its unique anatomical configuration and the absence of gastric https://scientific-jl.com/new 33 11 99 Volume–77_Issue-2_May-2025 JOURNAL OF NEW CENTURY INNOVATIONS air on radiographs, which complicates early diagnosis.Pure esophageal atresia typically presents with signs of excessive salivation, feeding difficulties, and respiratory distress shortly after birth. However, the lack of a TEF can delay recognition and intervention, especially in centers where neonatal surgical expertise is limited. In addition, this form of EA is often accompanied by other congenital anomalies, including cardiac, renal, and vertebral defects, which further complicate management and prognosis. The decision-making process regarding surgical correction is particularly challenging in these cases, as the esophageal segments are often significantly separated, making primary anastomosis technically difficult or even impossible in the neonatal period.The importance of timely and appropriate surgical intervention cannot be overstated. In the absence of a tracheoesophageal fistula, neonates are unable to swallow saliva or feed orally, necessitating prompt establishment of alternative nutritional routes, such as gastrostomy or parenteral nutrition. Furthermore, the timing and type of esophageal repair—whether primary, delayed primary, or esophageal replacement—must be carefully tailored to each patient’s anatomy, overall condition, and associated anomalies. In recent decades, advances in neonatal intensive care, surgical techniques, and perioperative management have significantly improved outcomes; however, morbidity and mortality remain higher in this subgroup compared to other types of EA. Given the rarity and complexity of pure esophageal atresia, optimal surgical strategy remains a subject of ongoing debate among pediatric surgeons. Various approaches have been described in the literature, including delayed primary anastomosis after esophageal elongation, staged reconstruction with initial gastrostomy, cervical or thoracic esophagostomy, and, in severe cases, esophageal substitution using stomach, colon, or jejunal interposition. Each method carries its own risks and benefits, and the decision largely depends on factors such as the length of the gap between the proximal and distal esophageal segments, the neonate’s general condition, and the presence of associated anomalies. Despite improvements in perioperative care, complications such as anastomotic leakage, strictures, gastroesophageal reflux, and long-term feeding difficulties remain significant concerns.Moreover, in low- and middle-income countries, including Uzbekistan, the management of such complex congenital anomalies is further challenged by limitations in neonatal intensive care resources, delayed referral, and variable access to advanced imaging and minimally invasive surgical techniques. As a result, standardized treatment protocols are often lacking, and individualized surgical decision-making becomes essential to improving outcomes. The present study aims to evaluate and analyze surgical management strategies employed in neonates with pure esophageal atresia treated at a regional pediatric surgical center. Through retrospective review and clinical assessment, we aim to identify effective treatment algorithms