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Anastomotic leakage following surgery for esophageal atresia
S Chittmittrapap1, L Spitz, E M Kiely
1Hospital for Sick Children, London, England.
Insights
Anastomotic leakage occurred in 17% of neonates undergoing esophageal atresia repair. Braided silk sutures significantly increased leakage risk, and leakage correlated with higher stricture formation rates.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Gastrointestinal Surgery
Background:
- Esophageal atresia repair is a complex neonatal procedure.
- Anastomotic leakage is a significant complication following esophageal atresia repair.
- Identifying risk factors and management strategies for anastomotic leakage is crucial.
Purpose of the Study:
- To determine the incidence of anastomotic leakage after esophageal atresia repair.
- To investigate the association between suture material and anastomotic leakage.
- To assess the relationship between anastomotic leakage and subsequent esophageal stricture formation.
Main Methods:
- Retrospective review of 199 neonates undergoing primary or delayed primary repair of esophageal atresia.
- Analysis of complication rates, including anastomotic leakage and stricture formation.
- Comparison of suture materials (braided silk, polyglycolic acid, polypropylene) and their association with leakage.
Main Results:
- Anastomotic leakage occurred in 17% of neonates (34/199), with 3.5% (7/199) being major disruptions requiring reoperation.
- Braided silk sutures were associated with a significantly increased risk of leakage (RR, 3.2) compared to polyglycolic acid (RR, 2.6) or polypropylene sutures.
- Anastomotic leakage significantly increased the risk of subsequent esophageal stricture formation (RR, 2.04).
- Gastroesophageal reflux was not associated with anastomotic leakage.
Conclusions:
- Anastomotic leakage is a notable complication in esophageal atresia repair, with major leaks requiring early reoperation.
- The choice of suture material is a critical factor, with braided silk posing a higher risk for leakage.
- Preventing anastomotic leakage is important to reduce the risk of long-term complications like esophageal strictures.
Abstract:
Of 199 neonates undergoing primary or delayed primary repair of esophageal atresia, 34 (17%) developed anastomotic leakage, 7 of which (3.5%) were major anastomotic disruptions. Infants with major leaks developed signs within 5 days and all required early reoperation, necessitating abandonment of the esophagus in 6. The remaining 27 were minor leaks demonstrated by water-soluble contrast studies and were successfully treated nonoperatively. Gastroesophageal reflux was unassociated with this complication but the use of braided silk sutures was associated with a significantly increased risk of anastomotic leakage when compared with polyglycolic acid (relative risk, 3.2) or polypropylene (relative risk, 2.6) sutures. Following anastomotic leakage there was a significantly increased risk (relative risk, 2.04) of subsequent esophageal stricture formation.