Management of esophageal atresia: Review of 16 years' experience

Sillén, Ulla; Hagberg, S; Rubenson, A.; Werkmäster, K

doi:10.1016/s0022-3468(88)80227-6

Cited by 59 publications

(39 citation statements)

References 19 publications

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“…Anastomotic leakage into the mediastinum occurs in 14-21% of the children who have undergone a surgical EA repair. Leaks result from the small, friable lower segment, ischemia of the esophageal ends, excess anastomotic tension [16,17], sepsis, poor suturing techniques, type of suture [18,19], excessive mobilization of distal pouch [20] and increased gap length [16,17,19]. These studies show that gap length can predict the chances of anastomotic leak because in cases of long gap anastomotic site is under tension, and excessive mobilization of both pouches is required for proper anastomosis.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of congenital tracheoesophageal fistula with esophageal atresia on the basis of gap length

et al. 2007

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Congenital tracheoesophageal fistula (TEF) with esophageal atresia (EA) is not an uncommon disease of newborns. Several classifications have been advocated for predicting the outcomes of these patients but all are physiological and concentrated on associated medical condition that influences survival. We emphasize a new classification on the basis of gap between two esophageal pouches to define the magnitude of surgical problems in the primary repair and correlate them with the outcomes in terms of anastomotic leak, esophageal stricture and mortality, keeping other prognostic factors constant. A total of 50 cases of congenital TEF with EA were included and all underwent primary esophageal anastomosis after the ligation of TEF. The gap between the two pouches was meticulously measured intraoperatively using a vernier caliper before the ligation of TEF, and patients were divided into four groups on the basis of gap length. Group A, where gap length was >3.5 cm (ultralong), group B where gap length was 2.1-3.5 cm (long gap), group C where gap length was >1 cm but not more than 2 cm (intermediate group) and group D, where the gap between two esophageal pouches was 1 cm or less (short gap). The incidence of anastomotic leak was 80, 50, 28, 10.5% and the incidence of esophageal stricture was 100, 75, 22.5, 19% after successful primary repair, respectively, in groups A, B, C and D. The mortality was highest in group A (80%) followed by group B (50%) and 22% in group C and least 15.6% in group D. The incidences of esophageal leak and mortality were found to be statistically significant. This classification which is based on easily measurable criteria provides a useful method to predict morbidity, long-term outcome and mortality of EA with TEF surgery.

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Section: Discussionmentioning

confidence: 99%

Prognosis of congenital tracheoesophageal fistula with esophageal atresia on the basis of gap length

et al. 2007

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“…Different other methods have been reported to make the anastomosis large, nontense and unrestricted to a single plane. Sulamaa et al gave the earliest description of such a technique describing an end to side anastomosis [18,19]. Sharma et al gave a method of suturing the upper puch to the anti spatulated end of the lower pouch in 1994.…”

Section: Discussionmentioning

confidence: 99%

http://medcraveonline.com/JPNC/JPNC-06-00234.php

Ghosh¹

2017

JPNC

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Purpose: Tracheo esophageal fistula repair are usually complicated by the development of anastomotic leaks and strictures. The technique of anastomosis has long been a matter of debate. The most common method has been transverse circular esophageal anastomosis. We aim to bring down the frequency of early complications associated with conventional technique of esophageal repair by introduction of a modified repair method.Methods: Twenty patients of congenital tracheo esophageal fistula underwent modified oblique esophago esophageal anastomosis with pleural patch. The patients were followed up for immediate complications of anastomotic leaks and strictures. Results: Contrast esophagogram showed no incidence of anastomotic leak and strictures in all the twenty patients. Conclusion:The oblique esophageal anastomois with pleural patch serves as a wide bore anastomosis compared to the classical circular anastomosis, hence explaining the reduced incidence of decreased leaks and strictures associated with this method.

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“…With recent advances in anesthesiology, surgical technology and materials, survival of cases undergoing EA with a TEF has significantly improved [4,[11][12][13] and birth weight over 1.5 kg or pneumonia are no longer included in risk factors [14,15]. Post-operative elective ventilator care with continuous administration of muscle relaxant for 3-6 days has certainly contributed Fig.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with EA with a TEF, gap length is usually estimated during surgery, but this is not always consistent, because it is liable to change by the timing of estimation, for instance, before or after the proximal esophageal pouch is dissected. Moreover, there is no definitive international guideline and the timing of estimation is seldom recorded in the literature [1][2][3][4][5][6][7][8][9]. Therefore, gap length in published papers may be puzzling.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, gap length has been employed as a measure for selection of surgical procedures [1][2][3][4][5][6][7][8][9] and the term 'long gap' has been utilized for cases which do not allow primary anastomosis to be readily performed. However, definition of the long gap is not uniform in literature and there is no definitive guideline to estimate gap length.…”

Section: Introductionmentioning

confidence: 99%

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Proposal of a novel method to evaluate anastomotic tension in esophageal atresia with a distal tracheoesophageal fistula

et al. 2005

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Anastomotic tension with the potential to lead to post-operative complication is usually evaluated using gap length before anastomosis in patients with esophageal atresia and a distal tracheoesophageal fistula (EA with a TEF). However a uniform, accurate measurement of gap length is not possible and estimation of the length the delicate distal esophageal stump is stretched by the anastomosis may have greater utility. The aim of this paper was to propose a novel method to evaluate the anastomotic tension in EA with a TEF. Forty consecutive patients having EA with a TEF were studied. Primary anastomosis without gastrostomy was performed in all cases. When the TEF was cut off, the most proximal site of the tracheal side was marked using a tiny metallic clip. When anastomosis was completed, the distance from the clip to the anastomotic site was measured as the stretched length. On the esophagram taken subsequently, the same distance was measured, together with the distance from the clip to the esophago-cardiac junction as the original distal esophageal length. The stretching ratio was calculated by dividing the former by the latter. The stretched length on esophagram (median: 3.0 mm, range: -12 to 21) was significantly correlated with that measured during surgery (median: 2.3 mm, range; -14 to 15) (r = 0.96, P < 0.0001). The median of original distal esophageal lengths was 60.0 mm (range: 35-80). The stretching ratio was significantly correlated with the stretched length, and the number of the stretching ratio as a percentage corresponded to about double the number of the stretched length on esophagram in millimeters (y = 1.91x + 0.58, r = 0.98, P<0.0001). Anastomotic leakage and recurrence of TEF were not experienced. In patients complicated with gastroesophageal reflux (GER), the site of TEF was significantly more distal as compared with the other cases [median (range): 5.0th (4.0-6.0) vs 3.5th (1.5-5.0) thoracic vertebral level, P<0.009]. The stretched length and the stretching ratio were also longer and larger, respectively [median (range): 10.0 mm (6-21) vs 2.0 (-12 to 14) mm, P<0.008, 17.3% (12.7-47.7) vs 2.9% (-16.4 to 29.8)%, P<0.018). Similar tendencies were observed for patients complicated with stricture. Estimation of the stretched length of the distal esophageal stump is useful to evaluate the anastomotic tension. If the stretched length is more than 10 mm, it will be necessary to consider the possibility that stricture or GER may arise afterwards.

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Management of esophageal atresia: Review of 16 years' experience

Cited by 59 publications

References 19 publications

Prognosis of congenital tracheoesophageal fistula with esophageal atresia on the basis of gap length

Prognosis of congenital tracheoesophageal fistula with esophageal atresia on the basis of gap length

http://medcraveonline.com/JPNC/JPNC-06-00234.php

Proposal of a novel method to evaluate anastomotic tension in esophageal atresia with a distal tracheoesophageal fistula

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