Rambam: Successful Laparoscopic Repair of a Baby’s Esophagus
Baby “D” was born with a rare birth defect in which her esophagus was split into two unconnected sections, preventing her from eating in a normal fashion. Recently, the pediatric surgical team at Rambam Health Care Campus successfully performed a complex surgical procedure on Baby D, and she is now able to eat and live a normal life. June 18, 2020 – When Baby “D” was born, she was diagnosed with a rare birth defect known as esophageal atresia, which occurs in about 1 in 3,000 births. While esophageal atresia can take many forms, in Baby D’s case, her esophagus was divided into two parts (referred to as an interruption), with a large gap of almost five inches separating the top section from the bottom. The upper section ended in a blind pouch, and the lower section connected her stomach to her respiratory tract, creating a situation where gastric juices could potentially leak into her lungs. Hence, Baby D faced a serious risk of infection and death. In fact, this precise birth defect as it existed in her tiny body is exceptionally rare, with only a few such instances described in the medical literature worldwide. The esophageal repair was performed using an innovative laparoscopic approach unique to Rambam. Most repairs of esophageal birth defects in babies and newborns are performed by open chest surgery. Laparoscopy, on the other hand, uses a minimally invasive technique whereby tiny incisions are made and small tubes are inserted into the baby's chest. Rambam is the only hospital in Israel that repairs esophageal birth defects laparoscopically. Laparoscopic surgery has clear advantages – the time to recovery is shorter and the pain and suffering of the child is greatly reduced. The alternative—open chest surgery—is accompanied by significant pain, risk of damage to ribs, and dangerous side effects, including scoliosis. "Treatment of esophageal atresia is generally performed with open chest surgery, by connecting the sections of the esophagus or by replacing part of the esophagus with artificial components," explains Dr. Arcady Vachyan, Director of the Pediatric Advanced Laparoscopic Surgery Unit at Rambam's Ruth Rappaport Children's Hospital, who performed the surgery on Baby D. "But there are other approaches to solving these complex issues in a creative fashion." Under the direction of Dr. Ran Steinberg, Rambam’s Department of Pediatric Surgery in Ruth Rappaport Children’s Hospital leads the nation in minimally invasive pediatric surgery and was the first to perform this type of surgery in Israel. Rambam has now acquired extensive experience in minimally invasive laparoscopic surgery, comparable to that of many of the world’s major medical centers. This expertise was put to great use by Rambam’s medical team, which performed a series of surgeries on Baby D in which the two parts of her esophagus were successfully connected. After a brief period of recovery, Baby D began to eat normally; following several days of hospitalization, she was able to return home feeling well. "We are talking about amazing results—against all the odds—which will allow this little girl to develop properly and have a normal life," said Dr. Vachyan. “We have the ability, knowledge, and experience to take care of these type of birth defects in a manner that not only resolves the issue, but also allows our tiniest patients to enjoy a great quality of life." In the photo: Baby D’s esophagus, before and after surgery. In the photo: Dr. Arcady Vachyan during the surgery. Photography courtesy of Rambam Health Care Campus.
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