Association of clinical factors with postoperative complications of esophageal atresia

Abstract

Background: Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) remains one of the most common gastrointestinal neonatal malformations. Even though postoperative management is standardized, it differs between hospitals and disease-associated clinical factors that may play a role in outcome have not yet been assessed in detail. Methods: In this monocentric retrospective study, data of 43 patients with EA between 2010 and 2018 were analyzed. Analysis includes assessment of the clinical background, surgical technique, postoperative management including application of continuous muscle relaxation (CMR), influence of coagulation parameters such as factor XIII and incidence of complications. Results: 21 patients (49%) were preterm infants with birth weights between 490 and 2840 g (median 1893 g). Only 35% (n Z 15) presented without any concomitant malformations. Within the entire study population, representing Vogt II, IIIb and IIIc, we observed an association between the development of a postoperative pneumothorax and anastomotic failure (AF) (p Z 0.0013). Furthermore, pneumothorax was associated with anastomotic stenosis (AS) in Vogt IIIb patients (p Z 0.0129). CMR (applied since March 2017 in 7 patients in an attempt to prevent anastomotic problems due to high complication rates) and coagulation factor XIII did not significantly correlate with postoperative outcome.

Reply - A brief comment on pneumothorax during the extubation period of esophageal atresia repair

“…We were able to identify the association between the occurrence of postoperative pneumothorax and other singular postoperative complications in our recent publication, which was addressed in a letter. 2 We would like to thank the authors of this letter for their interest and their comments. The authors presented two cases with pneumothorax after esophageal repair and believed that the application of high nasal continuous positive airway pressure (CPAP) induces pneumothoraxes.…”

“…We have already evaluated the timing of postoperative extubation and the occurrence of pneumothorax in the latest publication. 2 Additional data on these 13 patients are shown in Table 1. In 8/13 (62%) patients, pneumothorax occurred prior to extubation period and vice versa after extubation in 5/13 (38%) patients.…”

“…Postoperative clinical course of weaning in patients with pneumothorax after esophageal repair (proprtion of the study cohort from Besendörfer et al2 ).Available online at www.sciencedirect.com ScienceDirect journal homepa ge : http:// www. pediatr-neonatol.com…”

A brief comment on pneumothorax during extubation period of esophageal atresia repair

“…Furhermore, 33% of their patients reported that the cause of pneumothorax was not anastomotic leakage or recurrent fistula in every patient, and that it was independent of surgical technique, use of muscle relaxants or postoperative extubation time. 1 In light of the above information, we wanted to comment on the pneumothorax seen in our patients with EA. We follow up EA patients with fentanyl and/or muscle relaxant with a ventilator for up to 4e5 days postoperatively without hyper extension of the head.…”

Short-term and mid-term effects of thoracoscopic repair of esophageal atresia: No anastomotic leaks or conversions to open technique

“…Primary repair of esophageal atresia (EA) surgery includes division of the tracheoesophageal fistula (TEF) and precise esophageal anastomosis. Recent studies have shown that survival rates exceeded over 90% ( 1 – 3 ). In many pediatric surgery centers, in the case of a newborn with EA TEF, still, the mainstay of treatment is thoracotomy with an extrapleural ligation of the fistula and end-to-end anastomosis of esophageal segments.…”