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Oesophageal atresia: Are "long gap" patients at greater anesthetic risk?
Laura Powell1, Jacinta Frawley1, Joe Crameri2
1Department of Paediatric Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Vic., Australia.
Insights
Infants with long gap esophageal atresia face similar perioperative risks as other esophageal atresia cases. However, current surgical repairs for long gap esophageal atresia often involve longer anesthesia and multiple procedures.
Area of Science:
- Pediatric Surgery
- Congenital Malformations
- Esophageal Atresia Repair
Background:
- Long gap esophageal atresia (LGEA) affects about 10% of infants with esophageal atresia (EA).
- Surgical repair of LGEA is challenging and linked to significant postoperative complications.
- Understanding the perioperative course and outcomes of LGEA repair is crucial.
Purpose of the Study:
- To describe the perioperative course, morbidity, and early results of LGEA repair.
- To identify factors associated with complications in LGEA repair.
- To compare outcomes between LGEA and non-LGEA infants.
Main Methods:
- Single-center retrospective cohort study.
- Inclusion of consecutive infants with EA undergoing surgical repair from 2006 to 2017.
- Comparison of 44 LGEA infants with 195 non-LGEA infants.
Main Results:
- LGEA infants had a similar incidence of difficult intubation, intraoperative hypoxemia, and hypotension compared to non-LGEA infants.
- Non-LGEA infants had shorter surgical duration and mechanical ventilation times.
- In-hospital mortality was 15.9% for LGEA vs 5.6% for non-LGEA, without statistical significance.
Conclusions:
- LGEA infants experience comparable perioperative complications to non-LGEA infants.
- Current LGEA surgical techniques are associated with longer anesthesia times and may require staged procedures.
- Further research into optimizing LGEA repair is warranted.
Background:
Long gap oesophageal atresia occurs in approximately 10% of all oesophageal atresia infants and surgical repair is often difficult with significant postoperative complications. Our aim was to describe the perioperative course, morbidity, and early results following repair of long gap oesophageal atresia and to identify factors which may be associated with complications.
Methods:
This is a single center retrospective cohort study of consecutive patients with oesophageal atresia undergoing surgical repair at The Royal Children's Hospital Melbourne from January 2006 to June 2017.
Results:
Two hundred and thirty-nine consecutive oesophageal atresia infants included 44 long gap oesophageal atresia infants and 195 non-long gap infants. A high rate of prematurity (24.7%), major cardiac (17%), and other surgically relevant malformations (12.6%) was found in both groups. The median age at oesophageal anastomosis surgery was 65.5 days for the long gap group vs 1 day for the oesophageal atresia group (mean difference 56.8 days, 95% CI 48.1-65.5 days, P < .01). Surgery for long gap oesophageal atresia included immediate primary anastomosis (n = 10), delayed primary anastomosis (n = 11), oesophageal lengthening techniques (n = 12) and primary oesophageal replacement (n = 6). Long gap oesophageal atresia was not associated with an increased incidence of difficult intubation (OR 2.8, 95% CI 0.6-22.1, P = .17), intraoperative hypoxemia (OR 1.6, 95% CI 0.6-4.5, P = .32), or hypotension (OR 0.9, 95% CI 0.5-1.8, P = .81). The surgical duration (177.7 vs 202.1 minute, mean difference [95% CI], 28 [5.5-50.4 minutes], P = .04) and mean duration of postoperative mechanical ventilation (107 vs 199.8 hours, mean difference [95% CI], 91.8 [34.5-149.1 hours], P < .01) were shorter for the non-long gap group. Overall in-hospital mortality was 7.5% (15.9% long gap vs 5.6% non-long gap oesophageal atresia OR 1.1, 95% CI 0.4-3.4, P = .85).
Conclusion:
Long gap oesophageal atresia infants have a similar incidence of perioperative complications to other infants with oesophageal atresia. Current surgical approaches to long gap repair, however, are associated with longer anesthetic exposures and require multiple procedures in infancy to achieve oesophageal continuity.