Anorectal malformations: Early outcome analysis from a high-volume tertiary care institute

Gupta, Rahul; Gupta, Arun Kumar; Shukla, Arvind Kumar; Chaturvedi, Vinita; Tanger, Ramesh

doi:10.4103/mjdrdypu.mjdrdypu_59_18

Cited by 7 publications

(21 citation statements)

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“…This necessitated irrigation of the right thoracic cavity using saline, which provided a buffer against the irritating bile and gastric fluid present in their thorax [12][13][14]. This irrigation further helped in healing the leak by preventing adhesion and empyema formation [15]. To our knowledge, this approach has not yet been reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…One such complication is an anastomotic stricture, the most common complication that results from the postoperative repair of EA [16,17]. These very often result in esophageal stenosis and strictures, and in comparing the surgical interventions for EA repair, stenosis was more common after thoracoscopic repairs versus thoracotomies [13][14][15][16][17][18]. In 2016, one large retrospective study of 430 patients in India reported the survival at 29.77% and mortality at 68.84% [15].…”

Section: Discussionmentioning

confidence: 99%

“…These very often result in esophageal stenosis and strictures, and in comparing the surgical interventions for EA repair, stenosis was more common after thoracoscopic repairs versus thoracotomies [13][14][15][16][17][18]. In 2016, one large retrospective study of 430 patients in India reported the survival at 29.77% and mortality at 68.84% [15]. Data from other institutions in the 1990s shows survival rates to be higher, between 85-90% [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…Data from other institutions in the 1990s shows survival rates to be higher, between 85-90% [16][17][18]. This marked difference in high-volume tertiary centers in India, despite being 20 years later, is due to a multitude of factors, including delayed diagnoses (>50% of neonates diagnosed more than 24 hours after birth had developed pneumonia), timely transportation to a pediatric surgical facility, and the availability of resources such as beds, neonatal ventilators, and trained neonatal intensive care unit staff [15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, this approach has not yet been reported in the literature. In some of these cases, operative measures are required if the leak does not resolve [ 15 ]. Of note, another one of our patients developed right lung collapse but then improved spontaneously.…”

Section: Discussionmentioning

confidence: 99%

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Management of Early Post-Operative Complications of Esophageal Atresia With Tracheoesophageal Fistula: A Retrospective Study

Syed

Faqeeh

Othman³

et al. 2020

Cureus

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Background Esophageal atresia (EA) with tracheoesophageal fistula (TEF) is a rare congenital malformation of the trachea and the esophagus. While the condition can result in a debilitating clinical picture, its outcomes have significantly ameliorated in recent times. The diminishing mortality associated with the disease can be attributed to a myriad of factors, including surgical advances, specialized anesthetic care, and categorical ventilator provision. These advances have resulted in increased survival rates even in premature infants who present with exceedingly low birth weights. Nevertheless, the mortality surrounding the condition still remains exceedingly high in some parts of the world, including the Middle East and Asia. The aim of the present study is to identify and outline the management of the postoperative complications that are intricately linked with soaring mortality rates. Methods We conducted a single-center retrospective study, three years in duration, of all the patients who were operated for esophageal atresia with tracheoesophageal fistula. The exclusion criteria included patients who died before the operation and those who were referred to other centers for management. The study evaluated several factors, including the various postoperative complications, their adept management, and the eventual outcomes. Data pertaining to the patient demographics, treatment, and radiological and laboratory findings was obtained and eventually analyzed using the Statistical Package for Social Sciences (SPSS) version 23.0 (IBM Corp., Armonk, NY, USA) software. Results The present study included a total of 12 cases diagnosed in our hospital during the aforementioned study period. Of these patients, two patients (16.7%) died before operation because of associated severe congenital anomalies such as cardiac pathologies. Three patients were referred to other centers for management. These patients were excluded from our analysis. The remaining seven patients were included in our analysis. In our study, gastroesophageal reflux was the most common postoperative complication and was noted in six patients. Leakage of anastomosis was noted in two patients. Lung collapse was noted in merely one patient and was thus the least common complication. The overall mortality rate hovered around 28.6%. Conclusions While most patients who are surgically managed for esophageal atresia with tracheoesophageal fistula develop postoperative complications, these complications are amenable to conservative management through the means of antibiotics, ventilator support, and total parenteral nutrition.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Management of Early Post-Operative Complications of Esophageal Atresia With Tracheoesophageal Fistula: A Retrospective Study

Syed

Faqeeh

Othman³

et al. 2020

Cureus

View full text Add to dashboard Cite

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Clinical Profile, Outcomes and Predictors of Mortality in Neonates Operated for Gastrointestinal Anomalies in a Tertiary Neonatal Care Unit- An Observational Study

Jerry

Amboiram

Balakrishnan

et al. 2022

Journal of Indian Association of Pediatric Surgeons

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Background: Gastrointestinal (GI) malformations have varied short-term and long-term outcomes reported across various neonatal units in India. Methods: This descriptive study was done to study the clinical profile, outcomes and predictors of mortality in neonates operated for congenital GI malformations in a tertiary neonatal care unit in South India between years 2011 and 2020. Details were collected by retrospective review of the case sheets. Results: Total of 68 neonates were included with esophageal atresia (EA) in 10, infantile hypertrophic pyloric stenosis (IHPS) in 9, duodenal atresia (DA) in 10, ileal atresia in 8, jejunal atresia in 5, anorectal malformations (ARM) in 11, meconium ileus/peritonitis in 9, malrotation in 2, and Hirschsprung's disease (HD) in 4. Antenatal diagnosis was highest in DA (80%). Associated anomalies were maximum in EA (50%), the most common being vertebral, anal atresia, cardiac defects, tracheoesophageal fistula, renal and radial abnormalities, and limb abnormalities association (VACTERL). Overall mortality was 15%. IHPS, DA, Malrotation, HD and ARM had 100 % survival while ileal atresia had the least survival (38%). Gestational age <32 weeks (odds ratio [OR] 12.77 [1.96, 82.89]) and outborn babies (OR 5.55 [1.01, 30.33]) were significant predictors of mortality in babies operated for small intestinal anomalies. None of the surviving infants were moderately or severely underweight at follow-up. Conclusion: Overall survival of surgically correctable GI anomalies is good. Among the predictors for mortality, modifiable factors such as in-utero referral of antenatally diagnosed congenital anomalies need attention. One-fifth had associated anomalies highlighting the need to actively look for the same. Although these neonates are vulnerable for growth failure, they had optimal growth on follow-up possibly due to standardized total parenteral nutritional policy during neonatal intensive care unit stay.

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Factors affecting the outcome of neonates with anorectal malformation in a developing country

Nisar¹,

Iqbal²,

Javed³

et al. 2021

J Pediatr Adolesc Surg

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Background: The survival and outcome of neonates with anorectal malformations (ARM) have much improved in the developed countries due to optimal perioperative and postoperative care but in developing countries, sepsis, low birth weight, delayed presentation, and lack of intensive care for neonates are still important in affecting the outcome. This study was carried out to evaluate factors of poor outcome (mortality) in neonates with ARM. Method: This is a prospective analytical study. A total of 44 consecutive neonates with Anorectal malformations (ARM) presenting to the Department of Pediatric Surgery, The Children’s Hospital, Pakistan Institute of Medical Sciences, Islamabad, were included. Variables studied included age at presentation, gender, birth weight, type of malformation, sepsis at presentation, type of surgery performed, postoperative complications, and their relationship to the outcome. The statistical analysis was performed using SPSS version 21. Results: A total of 44 neonates with ARM were included in the study. In the study population, 56.8 % (25) were males and 43.2% (19) were females. The mean age at presentation was 2.1 ± 0.5 days. The mean birth weight was 2.5 ± 0.6 kg. Overall mortality was 29.5% (13) with 13.63% (6) patients died pre-operatively. The most common cause of death in postoperative patients was sepsis (40%). There was a statistically significant relationship between low birth weight (P= <0.01) and sepsis at presentation (P=0.001) with mortality. No statistically significant association was found when the outcome was compared with age at presentation (P=0.21) and postoperative complications (P=0.16). Conclusion: In developing countries, the lack of resources, lack of trained midwives/LHVs, intensive care are contributing factors to sepsis and delayed presentation, and ultimately mortality. Good antenatal care, awareness of the midwives/Lady Health Visitors to refer such patients in time, and provision of adequate intensive care can improve the outcome of surgery in ARMs.

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Anorectal malformations: Early outcome analysis from a high-volume tertiary care institute

Cited by 7 publications

References 0 publications

Management of Early Post-Operative Complications of Esophageal Atresia With Tracheoesophageal Fistula: A Retrospective Study

Management of Early Post-Operative Complications of Esophageal Atresia With Tracheoesophageal Fistula: A Retrospective Study

Clinical Profile, Outcomes and Predictors of Mortality in Neonates Operated for Gastrointestinal Anomalies in a Tertiary Neonatal Care Unit- An Observational Study

Factors affecting the outcome of neonates with anorectal malformation in a developing country

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