Morphological argumentations in complications of esophageal atresia with lower esotracheal fistula

Abstract

Introduction: Despite the notable success achieved in the treatment of esophageal atresia, the respiratory and gastrointestinal complications are observed quite frequently, some of them persisting throughout the whole life. Esophageal motility disorders occurring after successful surgical treatment of esophageal atresia with tracheoesophageal fistula are quite common, the etiology of which remains controversial. Anastomotic dehiscences, dysphagia, gastroesophageal reflux, impaired or absent peristalsis are the changes recorded clinically, radiologically, scintigraphically and endoscopically. Purpose and Objectives: to analyze the spectrum of pathomorphological changes revealed in both atretic segments of the esophagus in cases of esophageal atresia with lower esophagealtracheal fistula responsible for the development and evolution of postoperative complications. Materials and Methods: The histopathological study was performed on 21 cases, which included necropsy material performed on unoperated specimens from 8 newborns with esophageal atresia and distal tracheoesophageal fistula, in 13 cases - from operated newborns. Evaluation of macro- microanatomic peculiarities in esophageal atresia with lower esotracheal fistula was performed at 3 levels: upper atretic segment, esotracheal fistula level and lower segm ent. Serial sections were made of both the proximal segment (blunt) of the esophagus and distal segment with fistula. Methods for staining with hematoxylin-eosin, van Gieson and orceine were used. Results of this study allowed to conclude: • Presence of advanced structural pathomorphological changes can significantly influence the regenerative-reparative processes of the esophagus after reconstructive operations in cases of esophageal atresia with distal tracheoesophageal fistula. • Fibro-muscular dysplastic changes concomitant with pathological changes of ganglioneuronal structures are responsible for oesophageal motility disorders after reconstructive operations in cases of esophageal atresia with distal tracheoesophageal fistula. • In cases of esophageal atresia with distal tracheoesophageal fistula some concomitant structural defects may be present (non-communicating intramural duplicates of the proximal atretic segment, communicating esophageal duplicates of the distal segment) that remain undiagnosed preoperatively and during surgery, causing significant postoperative complications including anastomosis failure. • Presence of islets of foveolar gastric mucosa in the distal segment with tracheoesophageal fistula could be a favorable morphological substrate for development of Barrett's esophagus in patients with esophageal atresia.