Purpose or Case Report: Introduction:
Children with esophageal atresia, tracheoesophageal fistulas, and Hirschsprung disease often undergo early invasive surgeries to correct these anatomical malformations, ensuring adequate nutritional intake. However, over time, post-surgical anastomotic strictures can develop, leading to mechanical obstructions that impair swallowing or defecation. Traditional treatment for such strictures often involves re-do surgery, but this carries significant risks and recovery time. Our study explores the efficacy of a combined radiological and surgical approach to manage these strictures, aiming to reduce the need for further invasive surgeries.
Methods:
Between September 2022 and May 2023, we performed six procedures involving pediatric patients with symptomatic post-anastomotic strictures (five esophageal, one colorectal). Each patient presented with symptoms suggestive of mechanical obstruction, such as dysphagia or difficulty passing stool. Under general anesthesia, both a surgical consultant and an interventional radiologist performed the procedures. Initial endoscopy was followed by fluoroscopic guidance via a 0.018 wire introduced through the endoscope. Balloon dilatation, using a range of balloon sizes (10mm–27mm), was performed, and the outcomes were assessed via pre- and post-dilatation fluoroscopic imaging with water-soluble contrast. Repeat endoscopy was used to confirm the efficacy of the dilatation.
Results:
Of the six cases, five were successfully treated with balloon dilatation, with no immediate need for further invasive surgery. One case, although initially successful, required subsequent surgical intervention due to recurrent stricture. Post-procedural imaging and endoscopy confirmed patency in the remaining cases, with significant symptom improvement.
Discussion:
This study highlights the efficacy of a combined radiological and surgical approach in managing post-anastomotic strictures. The use of intraoperative endoscopic and fluoroscopic correlation allowed for precise dilatation, reducing the likelihood of recurrence and avoiding immediate re-do surgeries.
Conclusions:
A combined surgical and radiological approach to post-anastomotic strictures offers a less invasive, resource-efficient, and effective alternative to re-do surgery. The success rate of 83% demonstrates that balloon dilatation under fluoroscopic and endoscopic guidance is a valuable adjunct to conventional surgical management of these conditions.
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