Faster healing with minimally invasive 
surgery techniques for pediatric patients


Something was seriously wrong, endangering Mikaella “Mika” in her first days of life. She was born with a rare condition in which there is no direct connection between the mouth and stomach.


“It’s one of the most painful incisions that can be made on the body,” according to Dr. Tamir Keshen, a board certified general and pediatric surgeon at Cottage Children’s Hospital.


Fortunately, for both Mika and her parents, Dr. Keshen had just recently moved to Santa Barbara and joined Cottage’s medical staff , bringing to the area his unique experience in repairing this type of fistula using a less traumatic approach.


“The procedure has potential for a good outcome with minimal trauma. And if the fistula recurs, an operation can be performed later on if needed,” explains Dr. Keshen. His technique to obliterate the connection between the esophagus and trachea involved using a brush to “rough up” the surface of the fistula’s lining. The abrasion would cause inflammation and speed up the collapse of the fistula, he said. Dr. Keshen also plugged the passage with a biomaterial.


Unlike major surgery which can take hours, Dr. Keshen completed the procedure in 45 minutes. And rather than a week’s recovery time in the hospital with no solid foods, Mika was able to go home after one day of observation. She was able to drink fluids that same night, and resumed normal eating within two days.


“Our children are the most precious gifts in the world to us,” said Gil and Ella. “We are so grateful to Dr. Keshen for allowing us to continue to enjoy Mika for many years to come.”


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Tracheo-Esophageal Fistula

A fistula is an abnormal passage connecting two parts inside of the body. In this case, a gap in the trachea is causing an abnormal pathway between the esophagus and the trachea. A person with this life-threatening problem cannot swallow and digest food properly and is at risk of choking if saliva is breathed into the lungs.



Pediatric surgeon Dr. Tamir Keshen 
brings new expertise to town.

He’s a native of Miami who most recently was Director of Minimally Invasive Surgery at St. Louis Children’s Hospital in Missouri and Assistant Professor of Surgery and Pediatrics at the Washington University School of Medicine in St. Louis. Board certified in both General and Pediatric Surgery, his focus is minimally invasive surgery in both the chest and abdomen, including neonatal congenital anomalies, oncology, gastroesophageal reflux disease and pectus excavatum. A recognized researcher and author, Dr. Keshen’s areas of interest include surgical metabolism and surgical treatment of inflammatory bowel disease and adolescent obesity.