Does postoperative ventilation have an effect on the integrity of the anastomosis in repaired oesophageal atresia?

Beasley, S. W.

doi:10.1046/j.1440-1754.1999.00313.x

Cited by 13 publications

(5 citation statements)

References 12 publications

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“…[ 6 ] They also reported an increased incidence of all complications with increasing gap length in a series of 66 neonates and proposed that a classification based on gap length was more relevant in the modern era. [ 6 ] Our long gap patients also had much higher requirement of postoperative ventilation similar to the findings of Beasley[ 8 ] and Uchida et al . [ 9 ] The importance of gap length on the final outcome in EA patients have been well stressed by Upadhyaya et al .…”

Section: Discussionsupporting

confidence: 86%

Determinants of gap length in esophageal atresia with tracheoesophageal fistula and the impact of gap length on outcome

Rassiwala

Choudhury

Yadav

et al. 2016

J Indian Assoc Pediatr Surg

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Aim:This study was aimed at identifying factors which may affect the gap length in cases of esophageal atresia with tracheoesophageal fistula (EA-TEF) and whether gap length plays any role in determining the outcome.Materials and Methods:All consecutive cases of EA-TEF were included and different patient parameters were recorded. Plain radiographs with a nasogastric tube in the upper esophagus were taken. Patients were grouped into T1-T2; T2-T3; T3-T4; and T4 depending on the thoracic vertebral level of the arrest of the tube. During surgery, the gap length between the pouches was measured using a Vernier caliper and the patients were grouped into A, B, and C (gap length >2.1 cm; >1-≤2 cm and ≤1 cm). The operative gap groups were compared with the radiography groups and the other recorded parameters.Results:Total numbers of cases were 69. Birth weight was found to be significantly lower in Group A (mean = 2.14 kg) as compared to Group B (mean = 2.38 kg) and Group C patients (mean = 2.49 kg) (P = 0.016). The radiographic groups compared favorably with the intraoperative gap length groups (P < 0.001). The need for postoperative ventilation (70.83% in Group A vs. 36.84% in Group C, P = 0.032) and mortality (62.5%, 26.9% and 15.8% in Group A, B, and C, respectively, P = 0.003) co-related significantly with the gap length.Conclusion:Birth weight had a direct reciprocal relationship with the gap length. Radiographic assessment correlated with intraoperative gap length. Higher gap length was associated with increased need for postoperative ventilation and poor outcome.

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Section: Discussionsupporting

confidence: 86%

Determinants of gap length in esophageal atresia with tracheoesophageal fistula and the impact of gap length on outcome

Rassiwala

Choudhury

Yadav

et al. 2016

J Indian Assoc Pediatr Surg

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“…Therefore, we suggest that higher respiratory problems in IV group may relate with ventilation strategy and may not affected by these parameters. The issue of chest tube placement after the operation is also a controversial issue, and our results showed that the majority of patients in both groups had chest tubes inserted 13 …”

Section: Discussionmentioning

confidence: 70%

“…The issue of chest tube placement after the operation is also a controversial issue, and our results showed that the majority of patients in both groups had chest tubes inserted. 13 After EA repair, patients may receive elective respiratory support to eliminate probable anastomotic complications by decreasing the tension on esophageal anastomosis. In addition, concomitant patient-related risk factors such as prematurity and lung-related respiratory tract problems may result in a respiratory support requirement.…”

Section: Spitz Et Al Recommended That Patients With Tensioned Anasto-mentioning

confidence: 99%

The effect of postoperative ventilation strategies on postoperative complications and outcomes in patients with esophageal atresia: Results from the Turkish Esophageal Atresia Registry

Cömert

Güney

Durakbaşa

et al. 2022

Pediatric Pulmonology

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Objectives Postoperative ventilatory strategies in patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) may have an impact on early postoperative complications. Our national Esophageal Atresia Registry was evaluated to define a possible relationship between the type and duration of respiratory support on postoperative complications and outcome. Study Design Among the data registered by 31 centers between 2015 and 2021, patients with esophago‐esophageal anastomosis (EEA)/tracheoesophageal fistula (TEF) were divided into two groups; invasive ventilatory support (IV) and noninvasive ventilatory support and/or oxygen support (NIV‐OS). The demographic findings, gestational age, type of atresia, associated anomalies, and genetic malformations were evaluated. We compared the type of repair, gap length, chest tube insertion, follow‐up times, tensioned anastomosis, postoperative complications, esophageal dilatations, respiratory problems requiring treatment after the operation, and mortality rates. Results Among 650 registered patients, 502 patients with EEA/TEF repair included the study. Four hundred and seventy of patients require IV and 32 of them had NIV‐OS treatment. The IV group had lower mean birth weights and higher incidence of respiratory problems when compared to NIV‐OS group. Also, NIV‐OS group had significantly higher incidence of associated anomalies than IV groups. The rates of postoperative complications and mortality were not different between the IV and NIV‐OS groups. Conclusion We demonstrated that patients who required invasive ventilation had a higher incidence of low birth weight and respiratory morbidity. We found no relation between mode of postoperative ventilation and surgical complications. Randomized controlled trials and clinical guidelines are needed to define the best type of ventilation strategy in children with EA/TEF.

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“…Several authors have described the use of PEVS under paralysis with neck flexion after repair of EA for the purpose of reducing anastomotic complications by decreasing anastomotic tension [1,3,5,6]. In Japan, many medical institutes have supported the efficacy of this postoperative management of EA.…”

Section: Discussionmentioning

confidence: 99%

“…Several reports have demonstrated postoperative elective ventilatory support (PEVS) reduces anastomotic complications by decreasing anastomotic tension [1,3,5,6].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of postoperative elective ventilatory support for leakage protection in primary anastomosis of congenital esophageal atresia

et al. 2006

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Anastomotic complications after primary repair of congenital esophageal atresia (EA) are recognized and feared complications. A close association exists between anastomotic leakage and the tension of the anastomosis on the suture line. This study aimed to evaluate the efficacy of postoperative elective ventilation support (PEVS) under paralysis with neck flexion after primary repair of EA. Forty-two EA patients; 4 cases with type A and 38 with type C by Gross classification received primary or delayed primary anastomosis between 1979 and 2003. PEVS has been introduced in the postoperative management of all EA cases since 1998. Vecuronium bromide was administered together with fentanyl citrate for five postoperative days. Patients were retrospectively divided into two groups: with or without PEVS management. There was no difference in operation data such as gastrostomy construction, gap between esophageal upper and lower pouch, primary or delayed primary anastomosis. PEVS under paralysis with neck flexion reduced postoperative anastomotic leakages in primary anastomosis with or without a Livaditis procedure. PEVS did not adversely increase anastomotic stricture, atelectasis, severe gastro-esophageal reflux, prolong days on ventilatory support or decrease survival rate. PEVS is an effective management method to decrease anastomotic complications for EA neonates.

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Does postoperative ventilation have an effect on the integrity of the anastomosis in repaired oesophageal atresia?

Cited by 13 publications

References 12 publications

Determinants of gap length in esophageal atresia with tracheoesophageal fistula and the impact of gap length on outcome

Determinants of gap length in esophageal atresia with tracheoesophageal fistula and the impact of gap length on outcome

The effect of postoperative ventilation strategies on postoperative complications and outcomes in patients with esophageal atresia: Results from the Turkish Esophageal Atresia Registry

Efficacy of postoperative elective ventilatory support for leakage protection in primary anastomosis of congenital esophageal atresia

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