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Anastomotic leakage in oesophageal atresia. Diagnostic and therapeutic considerations
Insights
Anastomotic leakage following esophageal atresia repair occurs in up to 38% of cases. Rethoracotomy and resuture offer a successful treatment for transpleural repair leakage.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Neonatal Surgery
Background:
- Esophageal atresia repair carries a significant risk of anastomotic leakage, a major cause of mortality in neonates.
- Congenital esophageal atresia and tracheoesophageal fistula present complex surgical challenges.
- Anastomotic leakage complicates 5-38% of these operations, exacerbated by prematurity and other anomalies.
Purpose of the Study:
- To review diagnostic and therapeutic options for esophageal anastomotic leakage after congenital atresia repair.
- To present the authors' experience with managing anastomotic leakage in a series of esophageal atresia and/or tracheoesophageal fistula cases.
- To evaluate the efficacy of rethoracotomy and resuture for managing anastomotic disruptions.
Main Methods:
- Review of diagnostic and therapeutic strategies for esophageal anastomotic leakage.
- Presentation of a consecutive series of 37 patients with esophageal atresia and/or tracheoesophageal fistula.
- Analysis of 7 cases with anastomotic leakage, focusing on surgical approach and treatment outcomes.
Main Results:
- Seven out of 37 patients experienced anastomotic leakage within 2-8 days post-operation.
- Three cases with leakage were initially operated via a retropleural approach.
- Four cases with leakage, initially operated via a transpleural approach, underwent successful rethoracotomy and resuture.
Conclusions:
- Rethoracotomy and resuture is an effective treatment for anastomotic leakage in transpleurally operated esophageal atresia patients.
- This approach facilitates early pleural cavity debridement and lung re-expansion.
- The procedure accelerates secondary anastomotic healing and reduces the need for prolonged pleural drainage and nutritional support.
Abstract:
Oesophageal anastomotic leakage complicates 5-38% of operations performed for congenital atresia, and continues with prematurity and concomitant anomalies to be a cause of a fatal outcome. After a short review of the diagnostic and therapeutic possibilities of this complication the authors present their own series of 37 consecutive oesophageal atresia and/or oesophagotracheal fistula. Seven of these had anastomotic leakage within 2 to 8 days after operation. Three of them had been primarily operated on through a retropleural approach. The remaining four had had a transpleural approach and were all treated with an immediate rethoracotomy and resuture of the disruption with good primary results. A few cases reported earlier and the authors' present experience support the view that rethoracotomy and resuture of the disruption in transpleurally operated patients provides a method which allows early debridement of the pleural cavity and pulmonary reexpansion, accelerates secondary anastomotic healing and shortens the period needed for pleural drainage and intravenous nutrition.