Delayed primary anastomosis for esophageal atresia: 18 Months' to 11 years' follow-up

Puri, Prem; Ninan, George; Blake, N. S.; Fitzgerald, R. J.; Guiney, E. J.; O'Donnell, Barry

doi:10.1016/0022-3468(92)90573-p

Cited by 85 publications

(36 citation statements)

References 6 publications

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“…GOR has been diagnosed in 66% of the patients in our series and the majority of these required fundoplication to improve their symptoms. This is slightly higher than the reported incidence in the literature [2,10,11,16]. Barrett's oesophagus was seen in two of our children, and has been reported by others following surgery for EA with or without fistula [25,26].…”

Section: Discussioncontrasting

confidence: 56%

“…Although delayed primary anastomosis is feasible in the majority of children with pure EA, GOR and its complications have been recognized as a major source of morbidity [2,10,11,16]. GOR has been diagnosed in 66% of the patients in our series and the majority of these required fundoplication to improve their symptoms.…”

Section: Discussionmentioning

confidence: 94%

“…The initial management of the newborn with pure EA and the technique used to measure the gap between the two oesophageal segments are well standardized at our institutions and has been reported previously [8,10]. Data examined included: sex, gestational age, birth weight, Apgar scores, maternal history of polyhydramnios, associated anomalies, age when gastrostomy was performed, gap size at initial assessment (1-2 weeks post gastrostomy), follow-up gap size (assessed every 2-3 weeks), age at delayed primary anastomosis, whether circular myotomy or upper pouch elongation was performed, duration of postoperative ventilatory support and paralysis, immediate complications and management, late complications and management, time when gastrostomy feeds were stopped, hospital stay and mortality.…”

Section: Methodsmentioning

confidence: 99%

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Long-term results of delayed primary anastomosis for pure oesophageal atresia: a 27-year follow up

Paran

DeCaluwe²,

Corbally³

et al. 2007

Pediatr Surg Int

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The management of a newborn with pure oesophageal atresia continues to be challenging. We started treating babies with pure oesophageal atresia by delayed primary anastomosis in 1977. The purpose of this study was to review the long-term outcome in infants with pure oesophageal atresia (EA) treated by delayed primary anastomosis with special emphasis on gastroesophageal reflux (GOR) related morbidity. The medical charts of all patients treated by delayed primary anastomosis between 1977 and 2004 were retrospectively reviewed. All survivors were followed up with completion of a questionnaire and personal/phone interviews. There were 26 patients in total admitted during the 27-year study period with the diagnosis of pure oesophageal atresia. Three died prior to surgery due to associated anomalies; two had almost no distal oesophageal segment and underwent oesophageal replacement surgery. The remaining 21 children were treated with delayed primary anastomosis and made up our study group. There were four deaths (19%) in this group, and all were prior to 1980. The median gestational age was 35.5 weeks and the median birth weight was 2.6 kg; median initial gap was 3.7 cm and median preoperative gap was 1.5 cm; median age at operation was 80 days and the median hospital stay was 5.5 months. The median follow-up period was 13.5 years. Fourteen children (66%) developed symptomatic gastroesophageal reflux and nine of these needed fundoplication (43%). Sixteen children developed strictures at the anastomotic site; ten responded to repeated dilatations while six needed resection and reanastomosis. At the time of this study, 15 out of the 17 survivors (88%) were on normal diet with no respiratory problems and 2 (12%) were dependent on gastrostomy feeds. Our long-term follow-up data shows that the delayed primary anastomosis provides excellent functional results in patients born with pure oesophageal atresia. The high incidence of gastroesophageal reflux and associated morbidity requires early intervention to prevent ongoing feeding problems due to oesophagitis and stricture formation.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

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Long-term results of delayed primary anastomosis for pure oesophageal atresia: a 27-year follow up

Paran

DeCaluwe²,

Corbally³

et al. 2007

Pediatr Surg Int

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“…Delayed primary esophageal anastomosis is feasible in some of those with long gap between the two esophageal ends, although a high percentage of them develop esophageal stricture. 19,20 Like others, we do not routinely perform gastrostomy in our patients, 12 which has contributed to a low incidence of gastroesophageal reflux. We routinely pass a nasogastric tube before the anastomosis is completed and use this for feeding prior to oral feeding.…”

Section: Discussionmentioning

confidence: 92%

Esophageal Atresia and Tracheoesophageal Fistula

et al. 1997

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“…In the last two decades many new methods have been used to overcome the problem of the wide gap between the two oesophageal pouches to achieve a delayed primary anastomosis using the patient's own oesophagus [3]. For a delayed primary anastomosis, an accurate assessment of the distance between the two blind ends of the oesophagus is highly desirable.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of oesophageal atresia without fistula by three-dimensional computed tomography

Luo

Lin

Wang

2002

European Journal of Pediatrics

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Delayed primary anastomosis for esophageal atresia: 18 Months' to 11 years' follow-up

Cited by 85 publications

References 6 publications

Long-term results of delayed primary anastomosis for pure oesophageal atresia: a 27-year follow up

Long-term results of delayed primary anastomosis for pure oesophageal atresia: a 27-year follow up

Esophageal Atresia and Tracheoesophageal Fistula

Evaluation of oesophageal atresia without fistula by three-dimensional computed tomography

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