Multicentre survey on the current surgical management of oesophageal atresia in Belgium and Luxembourg

Reusens, Helena; Matthyssens, Lucas; Vercauteren, Charlotte; Renterghem, Katrien Van

doi:10.1016/j.jpedsurg.2016.11.010

Cited by 15 publications

(11 citation statements)

References 29 publications

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“…Anastomotic fistula is a common and dangerous recent anastomotic complication of oesophageal reconstruction. In this study, the incidence of anastomotic fistula was 26.3%, which is slightly higher than the 20% reported in other studies [ 6 ]. The occurrence of anastomotic fistula after anastomosis in adults is mainly related to anastomotic tension and anastomotic blood supply [ 7 ].…”

Section: Resultscontrasting

confidence: 69%

Risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia

Huang

Hong

Chen

et al. 2021

J Cardiothorac Surg

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Background Oesophageal atresia is a congenital malformation of the oesophagus and a serious malformation of the digestive system, postoperative complications include acute respiratory failure, pneumonia, anastomotic fistula, anastomotic stenosis, tracheal stenosis, gastroesophageal reflux and eosinophilic oesophagitis, anastomotic fistula is one of the important causes of postoperative death. The objective of this study is to identify the risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia. Methods A retrospective analysis was performed on the clinical data of 107 children with congenital oesophageal atresia who underwent one-stage anastomosis in our hospital from January 2013 to December 2018. Single-factor and multivariate logistic regression analyses were performed to determine the risk factors for anastomotic fistula and anastomotic stenosis. Results A total of 107 children with oesophageal atresia underwent one-stage anastomosis, and the incidence of anastomotic fistula was 26.2%. The probability of anastomotic stenosis in the long term was 52.3%, and the incidence of refractory stenosis (dilation ≥5 times) was 13.1%. Analysis of the clinical count data in the anastomotic fistula group and non-anastomotic fistula group showed that preoperative albumin (F = 4.199, P = 0.043), low birth weight (F = 7.668, P = 0.007) and long gap defects (F = 6.107, P = 0.015) were risk factors for postoperative anastomotic fistula. Further multivariate logistic regression analysis showed that low birth weight (Wald2 = 4.499, P = 0.034, OR = 2.775) and long gap defects (Wald2 = 6.769, P = 0.009, OR = 4.939) were independent risk factors for postoperative anastomotic fistula. Premature delivery (F = 5.338, P = 0.023), anastomotic fistula (F = 11.381, P = 0.001), endoscopic surgery (F = 6.343, P = 0.013), preoperative neutrophil count (F = 8.602, P = 0.004), preoperative low albumin (F = 8.410, P = 0.005), and a preoperative prognostic nutritional index < 54 (F = 5.54, P = 0.02) were risk factors for refractory anastomotic stenosis in children. Further multivariate logistic regression analysis showed that postoperative anastomotic fistula (Wald2 = 11.417, P = 0.001, OR = 8.798), endoscopic surgery (Wald2 = 9.633, P = 0.002, OR = 4.808), and a prognostic nutritional index < 54 (Wald2 = 4.540, P = 0.002, OR = 2.3798) were independent risk factors for refractory anastomotic stenosis. Conclusion Low birth weight and long gap defects are important predictors of postoperative anastomotic fistula, and the possibility of refractory anastomotic stenosis should be considered. The long-term risk of anastomotic stenosis was increased in children undergoing endoscopic surgery and in those with a preoperative prognostic nutritional index < 54.

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Section: Resultscontrasting

confidence: 69%

Risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia

Huang

Hong

Chen

et al. 2021

J Cardiothorac Surg

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“…One of the early complications of EA is anastomotic leakage, which has been reported in literature at rates of 10%-34% (15,16). In the current study, only one (4%) patient had anastomotic leakage.…”

Section: Discussionmentioning

confidence: 41%

Özefagus Atrezisi ve Trakeoözefageal Fistül Deneyimlerimiz

Karakaya¹,

Güler²,

Doğan³

et al. 2021

Osmangazi̇ Journal of Medicine

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To evaluate the treatment results of patients who were operated with the diagnosis of esophageal atresia and tracheoesophageal fistula (EA and TEF) in our clinic. The results of patients who were operated with the diagnosis of esophageal atresia and tracheaesophageal fistula between April 2017 and November 2019 were retrospectively evaluated. The patients were evaluated in terms of gestational age, birth weight, gender, atresia type, surgical approach, and duration of treatment. Postoperative mechanical ventilator follow-up was examined in terms of the transition time to nasogastric tube and oral feeding, and complications. A total of 24 patients, 20 (83%) boys and 4 (17%) girls, were included in the study. The mean age at surgery was 3.9 days. The gestational age of the patients was 35 weeks and the mean birth weight was 2391 grams. Distal tracheaesophageal fistula + proximal atresia were detected in 22 (92%) patients. Congenital heart disease was detected in 14 (58%) patients. The follow-up time in the ventilator was 27 hours, and the average oral feeding time was 11 days. Three (12.5%) patients died. Hospital stay was 16 days. During their follow-up, anastomotic stenosis was observed in 5 (21%) patients, and anastomotic leakage was observed in one (4%) patient. EA and TEF are anomalies that can be highly cured with surgical treatment. The follow-up of patients with EA by the neonatal team is important for the follow-up and treatment of additional anomalies. Therefore, these patients should be followed up with a multidisciplinary approach. Families should be informed about the frequent postoperative anastomotic stenosis.

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“…35,36 Concerning staplers, we have previously shown that their use is currently not advisable due to size discrepancy between staplers and patient's anatomy. 37 Moreover, the vast majority of operations for esophageal atresia are still conducted via the open approach, 38,39 which also suggests the comparison of handsewn techniques would have the widest relevance for the practicing pediatric surgeon.…”

Section: Discussionmentioning

confidence: 99%

A Continuous Suture Anastomosis Outperforms a Simple Interrupted Suture Anastomosis in Esophageal Elongation

et al. 2020

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Introduction Long-gap esophageal atresia represents a distinct entity among the esophageal atresia spectrum. In many patients, achieving a reasonable anastomosis depends on some millimeters of tissue. We aimed to determine what effect the suturing technique would have on esophageal ex vivo elongation as it may determine the strength of a primary anastomosis. Materials and Methods In an analysis of porcine esophagi from animals for slaughter (100–120 days old with a weight of 100–120 kg), we determined esophageal length gain of simple continuous and simple interrupted suture anastomoses subjected to linear traction until linear breaking strength was reached. Statistical power of 80% was ensured based on an a priori power analysis using five specimens per group in a separate exploratory experiment. Results The simple continuous suture anastomosis in 15 porcine esophagi ( = 4.47 cm, 95% confidence interval: 4.08–4.74 cm) outperformed the simple interrupted suture anastomosis in another 15 esophagi ( = 3.03 cm, 95% confidence interval: 2.59–3.43 cm) in length gain (Δ = 1.44 cm, 95% confidence interval: 0.87–2.01 cm, p < 0.0001). Conclusion Simple continuous anastomoses achieved higher length gain compared with simple interrupted suture anastomoses. This effect warrants an experimental assessment in vivo to assess its potential merits for clinical applicability.

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Multicentre survey on the current surgical management of oesophageal atresia in Belgium and Luxembourg

Cited by 15 publications

References 29 publications

Risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia

Risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia

Özefagus Atrezisi ve Trakeoözefageal Fistül Deneyimlerimiz

A Continuous Suture Anastomosis Outperforms a Simple Interrupted Suture Anastomosis in Esophageal Elongation

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