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Measured gap length and outcomes in oesophageal atresia
Hemanshoo S Thakkar1, Joseph Cooney1, Neetu Kumar1
1Division of Paediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK.
Insights
Oesophageal atresia (OA) gap length did not correlate with leaks or strictures. However, longer gaps in OA repair increased the need for fundoplication, suggesting gap length is irrelevant for primary repair complications.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Gastrointestinal Surgery
Background:
- Oesophageal atresia (OA) with or without tracheoesophageal fistula (TOF) is a common congenital esophageal anomaly.
- Limited data exists on the relationship between OA gap length and complication rates.
- Investigating this relationship is crucial for optimizing surgical outcomes.
Purpose of the Study:
- To assess the correlation between measured oesophageal gap length during OA repair and major post-operative complications.
- To determine if gap length influences the incidence of anastomotic leak, strictures, GORD, and need for fundoplication.
Main Methods:
- Retrospective analysis of 122 OA +/- TOF patients undergoing repair between 1983-2012.
- Patients categorized into short (≤1cm), intermediate (>1-≤2cm), and long (>2-≤5cm) gap groups based on intraoperative measurement.
- Outcomes analyzed: anastomotic leak, strictures, gastroesophageal reflux disease (GORD), and fundoplication.
Main Results:
- No significant linear relationship found between gap length and anastomotic leak (P=0.66) or stricture rates (P=0.67).
- Gastroesophageal reflux disease (GORD) rates showed a trend towards increase with gap length (51% to 72%, P=0.58).
- A significant increase in the need for fundoplication was observed in the long gap group (44%, P=0.02).
Conclusions:
- Intraoperative oesophageal gap length does not appear to be a significant predictor of anastomotic leak or stricture formation in OA repair.
- While primary repair is feasible, absolute gap length may not influence early post-operative complications.
- Longer oesophageal gaps are associated with a higher incidence of requiring fundoplication, indicating a potential long-term management consideration.
Aims:
Oesophageal atresia (OA) with or without tracheoesophageal fistula (TOF) is the most common congenital anomaly of the oesophagus. There is limited literature suggesting a linear relationship between increasing gap length and the incidence of all major complications. We sought to assess whether measured gap length at the time of surgery was related to outcomes in our patients.
Methods:
All patients with a diagnosis of OA +/- TOF who underwent repair under a single surgeon between 1983 and 2012 were included. The length between the oesophageal pouches was measured at the time of surgery. Patients were then divided into three groups; short ≤1cm, intermediate >1-≤2cm and long >2-≤5cm. Outcome measures were anastomotic leak, strictures requiring dilatation, gastrooesophageal reflux disease (GORD) and need for fundoplication.
Results:
122 patients were included in the study. The outcomes for patients with short (n=53), intermediate (n=51) and long gaps (n=18) were as follows: anastomotic leak - 1.9%, 2%, 5.5% (P=0.66), strictures requiring dilatation - 32%, 33%, 50% (P=0.67), GORD - 51%, 59%, 72% (P=0.58) and need for fundoplication - 11%, 20%, 44% (*P=0.02). There were no deaths related to the repair.
Conclusions:
Measured gap length at the time of surgery did not have a linear relationship with leak or stricture rate. Our experience suggests that when primary repair is possible absolute gap length is irrelevant to the development of post-operative complications. There is however a significant increase in the need for fundoplication in those with a long gap.
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