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Nov, 21.
2014

The Taste of Ice Cream on the Tongue

Veronika, 2, with Klaus Schaarschmidt, chief of pediatric surgery, and Nastasja, 3. (from left)

 

Berlin doctors successfully treated two girls with malformed esophai

Excited and wide-eyed, Veronika points to the wall and watches what is appearing there at the moment: a photograph showing her from only a few weeks ago. But the child in the picture hardly resembles the three-year-old blonde girl with a polka-dot dress and pigtails, squirming in her mother’s lap. Since the earlier photo was taken, the most complicated operation that Klaus Schaarschmidt can imagine has taken place. “This is what makes our profession so beautiful,” says the chief of pediatric surgery at the Klinikum Berlin-Buch, “the fact that we can make critically ill children healthy again.”

 

Other doctors had given up

In August, Veronika lay on the operating table before him for twelve-and-a-half hours. The tiny girl from Siberia suffered from a very rare and serious deformity since her birth: she came into the world with a dysfunctional esophagus. One child in 3,500 is born with this “esophageal atresia” worldwide. Doctors from around the world had already given up on Veronika’s deformity and pronounced it inoperable, as they had also done for the two-year-old Nastasja, whom Schaarschmidt also operated on in August with his interdisciplinary expert team. Like Veronika, Nastasja came into the world with a congenital esophageal occlusion. Until that point, neither girl could swallow, eat or drink on her own. “We always fed them with syringes through an opening in their stomachs,” explains the visibly relieved mother of Nastasja, Nataša S. “But she insisted on eating alone, so everything she put in her mouth came out again through the opening in her neck.” In the area of dysfunctional esophagi, current medicine has not progressed in the last 100 years, says Klaus Schaarschmidt. “As early as 1913, the esophagus was replaced by a rubber tube that ran along the front of the body, leading from a hole in the neck through a hole in the abdomen to the stomach.” Nastasja had also been fitted with such a device as an interim solution, but it was not enough. “When I first saw the three-year-old, she had the size and weight of a seven-month-old child,” Schaarschmidt explains. “Both children were undernourished and were not growing.” Nastasja and Veronika already had to endure many operations. At first, surgeons tried to stitch the dysfunctional esophagus together, but the sutures leaked. In Nastasja’s case, this happened even during the second attempt: pus ran into her chest and abdomen and she got a 42 degree fever. Finally, her esophagus was completely removed and the aforementioned external stomach tube attached. “Both girls had adhesions from the previous operations, therefore the operations took even longer,” remembers anesthesiologist Jochen Strauß. “Besides, such children are very sensitive to anesthesia due to their extreme undernourishment, and are more prone to cardiac arrhythmias.”

 

A gastric pull-up saved them

But both operations ran smoothly. The doctors in both cases opted for a gastric pull-up procedure, which involved removing part of the stomach, shaping it into a tube, and stitching it to the throat. “The stomach tissue is the best replacement for an esophagus, since it grows at the same speed as the child,” says Scharrschmidt. This is not the case with the large intestine, which was first used as a replacement in Veronika’s case. Besides that, it would smell, because it produced feces in her throat. But now the girls can finally eat, drink and swallow by themselves. Due to their reduced stomach volume, they must eat more frequently and in smaller portions, but this is probably the only restriction that will remain in their lives. “Swallowing is going well,” says Veronika’s mother Svetlana U. “We practiced it many times in advance.” Since the operations, both children have gained a kilogram. “I still can’t believe it,” says Nataša S. glancing at her daughter, “that she simply craves food by herself now. We are so happy and grateful.” What does Nastasja like to eat the most? Chocolate? No, her mother laughs. “Sausage and ham!”

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