Surgeons use pioneering new technique to save lives of babies born without an oesophagus
An expert surgical team at Birmingham Children’s Hospital has successfully pioneered a life-saving technique that will help babies born without part of their oesophagus.
Using state-of-the-art thoracoscopic equipment (also known as keyhole surgery in the chest), patients with the rarest form of the life-threatening birth defect, oesophageal atresia, have been successfully treated using the new technique first used last winter.
The condition results in babies being born without part of the oesophagus - the tube that connects the mouth to the stomach. Instead, it grows in two separate segments that do not connect leaving children not even able to swallow his/her own saliva, let alone feed by mouth.
Previously, if there was a long gap separating the upper and lower ends of the oesophagus, the only surgical treatment was to replace the missing section with part of a bowel taken from another part of the abdomen. This would involve a number of operations spread over about two years during which time the babies would be fed by a gastrostomy tube directly into the stomach.
The new method involved three operations performed over just a week with surgeons using the latest keyhole technology, operating in a space around the size of a matchbox between the heart and lungs.
The operation started with finding the disconnected parts of the oesophagus and then placing sutures to gently stretch and pull the ends closer together. By the third operation, the ends could be sewed together using 3mm keyhole instruments. Each operation took two to four hours and required a team of surgeons, anaesthetists, theatre nurses and intensive care specialists.
The moment of truth comes around a week after the surgery when the baby is given their first ever drink and a series of x-rays are taken to check whether the milk flows down into the baby’s new oesophagus. Once the operation has shown to be a success, the baby has to learn to feed by mouth – enabling them and their family to enjoy a virtually normal quality of life.
One of the handful of babies to benefit from the pioneering technique has been Olivia Evans, now aged six months, who captivated the nation in the latest episode of the BBC documentary series, Life and Birth (Tuesday 28 April), which told the pregnancy journey of parents, Kirsten and Mark.
Kirsten explained the difference it’s made to her family, who are from Cannock, Staffordshire:
“When we found out about Olivia-Hope’s condition, we were absolutely terrified of what the future held for her. Coming to Birmingham Children’s Hospital has been a life and game changer for our daughter.
“We were told about the possible new technique that could be used and I’ll be honest, as new parents we were terrified of them doing something so new. However looking at Rohan and how well he was doing allowed us to feel a lot more comfortable and wow has it been incredible.
“The surgical team and the nurses on the Neonatal Surgical Ward who dealt with Olivia-Hope were absolutely incredible. ‘Little Liv’ as they called her thrived with their care.”
Rohan Aytain-Jenkins, now aged eight months, was the first patient to undergo the new procedure when he was just a few weeks old.
When he was born his oesophageal atresia meant he couldn’t even swallow his saliva. Specialist nurses on the Neonatal Surgical Ward at Birmingham Children’s Hospital had to continuously suction his mouth to stop him from inhaling his saliva into his windpipe and lungs – which could lead to life-threatening breathing difficulties.
Mum Amreeta, from Sutton Coldfield, explained:
“We first knew at our 20-week scan that there was an issue with Rohan’s oesophagus but it wasn’t until he was born that we were told it was oesophageal atresia.
“Thanks to the expertise and sheer dedication of the team at the Children’s Hospital they caught the early signs of his condition and outlined the best treatment options available to us. They guided us every step of the way, explaining things clearly but also making sure we understood that this operation had not previously been attempted in the UK. We knew we wanted to give Rohan the best possible chance and that we were in safe hands.”
The team that carried out the new type of surgery, used originally in The Netherlands, was led by Consultant Paediatric Surgeons Mr Suren Arul, Mr Ingo Jester and Mr Giampiero Soccorso along with a dedicated team of nurses, theatre staff, anaesthetists and intensive care doctors.
The surgery was performed in the laparoscopic surgery suite at Birmingham Children’s Hospital which was opened 10 years ago and was one of the very first high definition laparoscopic operating suites for children in the UK.
Over the last six months, other babies, including Joshua Hall (pictured) have also benefitted from this keyhole surgery technique to treat their oesophageal atresia and are now thriving at home with their families.
Mr Arul, Consultant Paediatric Surgeon at Birmingham Women’s and Children’s NHS Foundation Trust, said:
"This was a complex and technically difficult piece of surgery that had never been attempted in our hospital before. We had a dedicated team of over a dozen doctors and nurses working during the three procedures and then many more of our specialist teams involved with the on-going care of our patient. To see this number of babies born with this form of oesophageal atresia in a period of just a couple of months is extremely rare. The parents have said their babies’ treatment has been a miracle. Certainly during my years as a children’s surgeon, this is one of the most exciting new operations I’ve been involved in."
"Everyone involved is amazingly proud to have successfully used the latest modern technology to perform this new operation for children born with this life-threatening condition of oesophageal atresia. This success is not just for them and their families now but also for other babies with similar conditions in the future."