In a world-first, the Montreal Children’s Hospital used new procedure to ‘create’ an esophagus so newborn can eat
It is fair to say the team at the Montreal Children’s Hospital (the Children’s) is always looking for innovative ways to save the lives of the newborns, children and teens in its care. In the case of Henryk, born at 33-weeks gestation, they went the distance. Henryk became the first newborn in the world to undergo a new procedure to fix his esophageal atresia, a birth defect in which part of a baby's esophagus (the tube that connects the mouth to the stomach) is missing. Then, later in his first year of life, the Children's team used a hand-made stent (tube) to allow the child to eat.
Babies with esophageal atresia are unable to eat and swallow. In most cases, a surgeon can bridge the gap between the upper and lower portions of the esophagus, and create a connection soon after birth. But in a rarer form called long-gap atresia, the distance between the two ends is very long, so surgeons wait until the newborn is about three months old before trying to stretch and then join the two ends of the esophagus. A newer technique, known as Flourish®, uses magnets placed inside each end of the esophagus, which slowly attract each other and create a connection.
A puzzle to solve
“We couldn’t use the Flourish® technique on Henryk,.” explains Dr. Sherif Emil, director of the Harvey E. Beardmore Division of Pediatric Surgery at the Children’s. “He had the most severe type of long-gap atresia; there was no lower esophagus in the chest, so nothing to stretch; nowhere to place a magnet. We knew this was going to be really challenging.”
While the baby was receiving care in the neonatal intensive care unit (NICU), Dr. Emil and his senior colleague, Dr. Jean-Martin Laberge, devised a hybrid procedure for Henryk, which had never been attempted before. They would divide his stomach in a way that would allow the tiny remaining part of his lower esophagus attached to it to be brought up into the chest and then use the magnets to create a connection between the two ends.
Kissing magnets
The procedure was high-risk, so Dr. Emil shared all plans and decisions with Joy and Michael, the baby’s parents. In addition, he had to educate the entire multi-disciplinary NICU healthcare team and obtain Health Canada’s approval to do this novel operation.
“Nobody in the world has tried this type of procedure before, but I knew this made the most sense for this little boy," said Dr. Emil. "During a 10-hour procedure, we confirmed the absence of a lower esophagus in the chest, then we went into the belly, swung a portion of the stomach up into the chest, went back into the chest, and applied the magnets. It was quite something.”
After the surgery, there was nothing to do but wait for the two magnets to pull towards each other, but in Henryk’s case, nothing was happening: the two magnets remained stubbornly apart. Several manipulations were needed under X-ray guidance, with the assistance of Dr. Karl Muchantef, interventional radiologist. Then, on day 10, they met up. A few days later, Dr. Emil could confirm the two structures had been joined. “I went out of the radiology suite, showed the parents the kissing magnets I had just removed, and told them, ‘we have an esophagus!’
A handmade stent to keep the baby’s esophagus open
Part of the problem was solved. The doctors still had to dilate Henryk’s narrow esophagus, which kept closing up.
“After about seven or eight dilatations performed by gastroenterologist Dr. Ana Sant’Anna, we knew we had to try something more permanent. So, we handmade a special stent described by Italian surgeons, which doesn’t put any pressure on the walls of Henryk’s esophagus and keeps the space inside it open."
Slowly, Henryk started to swallow saliva and soon he was able to drink milk with the stent in place until it was removed six weeks later. By then, he was able to be fed by mouth.
“Dr. Emil and his team were open to thinking outside the box, in innovative ways,” says Henryk’s mom. “They were open to collaborating with other physicians at other institutions, and they were exploring different possibilities that would work for our son and be safe for him. We are just so grateful. We can’t imagine having gone through this at any other hospital.”
After a long sojourn in hospital and many procedures, Henryk, who is now two, is thriving at home, but will continue to be followed by his team at the Children’s.
Sharing knowledge with the world
The word is spreading about the new procedure done at the Children’s. Dr. Emil is fielding calls from colleagues around the world wanting to know how they can use it to help similar children in their care.
The Montreal Children’s Hospital Foundation and The Harvey E. Beardmore Pediatric Surgery team offer a huge thank you to the many donors who support their work and make these types of ground-breaking surgery possible, including the Mirella & Lino Saputo Foundation, Groupe Monahan Desautels, the Adam & Tammy Saskin family and the Zoe Saskin Ski for the Children’s fundraising event.