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Khirurgii

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Year 2018 Vol. 26 No 1

PEDIATRIC SURGERY

A.N. VORONETSKY 1, A.E. DANOVICH 2

NEODYMIUM LASER IN TREATMENT OF CONGENITAL TRACHEOESOPHAGEAL FISTULA IN CHILDREN

Belarusian State Medical University 1,
6th Municipal Clinical Hospital 2, Minsk
The Republic of Belarus

Objective. To evaluate the efficiency of neodymium laser with an endoscopic support in the treatment of tracheoesophageal fistula in children.
Methods. Laser technology has been used in the treatment of 8 children with tracheoesophageal fistula (TEF) at the age of 1 month and 26 days to 7 years. One has used the medical multifunctional laser complex Multiline (Belarus), gastroscope «Olympus GIF-XP190N», bronchoscope «Olympus MAF TYPE GM». When performing esophagoscopy and bronchoscopy, the distal segment of the light guide was introduced in the fistula and at the contact impact of the neodymium laser with a wavelength of 1340 nm to the mucous membrane of the fistula with the exposure of 2-3 seconds at a radiation power of 15 watts, the tissues with obliteration of the fistulous duct were coagulated and evaporated.
Results. 8 children had the congenital TÅF; one child had the isolated TÅF, in 7 children it combined with the esophageal atresia. In all children with esophageal atresia, esophageo-esophageal anastomosis was applied with TEF uncoupling in the first or second day after birth. The cause for the TEF laser ablation was fistula recurrence in all of these 8 children. The therapeutic effect with closing the fistula entrance was achieved in 6 children with fistula entrance diameter no more than 3 mm. One child after laser TÅF ablation with fistula entrance diameter of 5 mm had recurrence and re-ablation was required. TÅF was not closed after five sessions of laser therapy in a child with a 4 mm fistula entrance.
Conclusions. Laser ablation of tracheoesophageal fistula can be applied in children when fistula entrance diameter is no more than 3.0 mm. The method is not traumatic and allows providing the physiological function of respiration without surgical intervention.

Keywords: tracheoesophageal fistula, neodymium laser, endoscopy, laser ablation, esophageal atresia, child
p. 60-65 of the original issue
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Address for correspondence:
220116, The Republic of Belarus,
Minsk, Dzerzhinsky Ave., 83,
Belarusian State Medical University,
Pediatric Surgery Department,
Tel. mobile: +375 029 32-902-32,
e-mail: anvoron@mail.ru,
Voronetsky Alexandr N.
Information about the authors:
Voronetsky Alexandr N., PhD, Associate Professor of the Pediatric Surgery Department, Belarusian State Medical University, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-7091-376X
Danovich Aleksandr E., Head of the Endoscopy Unit, 6th Municipal Clinical Hospital, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-2116-4675
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