Elective, postoperative ventilation in the management of esophageal atresia and tracheoesophageal fistula

Al-Salem, Ahmed H.; Qaisaruddin, Syed; Srair, Hussain Abu; Dabbous, Ibrahim; Al-Hayek, R.

doi:10.1007/bf01372145

Cited by 26 publications

(10 citation statements)

References 17 publications

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“…Al‐Salem et al 11 reviewed 20 patients who were treated in a variety of ways. The biggest group was 15 patients with atresia and a distal fistula, 14 of whom had a primary repair.…”

Section: Review Of Evidencementioning

confidence: 99%

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

Beasley

1999

J Paediatrics Child Health

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Several authors have claimed that the use of postoperative ventilation or graded withdrawal of respiratory support reduces the incidence of anastomotic complications after repair of oesophageal atresia, particularly where the gap between the oesophageal ends has been extensive or where the anastomosis has been constructed under tension. Careful review of their data reveals little objective evidence to either support or refute this contention. Many institutions are achieving low leakage rates following oesophageal anastomosis in oesophageal atresia, but to date there has been no controlled study to show that the use of neck flexion, muscle paralysis, intubation and assisted ventilation postoperatively influences the integrity of the anastomosis. The sequence of observations that led to the presumed relationship between postoperative ventilation and oesophageal leak is reviewed. It would appear that the effect of postoperative ventilation and paralysis on the oesophageal anastomosis is yet to be determined.

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“…Al‐Salem et al 11 reviewed 20 patients who were treated in a variety of ways. The biggest group was 15 patients with atresia and a distal fistula, 14 of whom had a primary repair.…”

Section: Review Of Evidencementioning

confidence: 99%

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

Beasley

1999

J Paediatrics Child Health

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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: 97%

“…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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“…15 We consider that using ventilatory support in early post-operative period avoids the need for initial vigorous physiotherapy. As a result, the anastomosis can be rested and protected from injury, and in addition, the prevention of postoperative respiratory distress will maintain adequate tissue PaO2.…”

Section: Discussionmentioning

confidence: 99%

Strategies for optimizing surgical outcome in patients with esophageal atresia with tracheo-esophageal fistula

Patil

Prakash

2017

Int Surg J

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Background: There have been major advances in the surgery for esophageal atresia (EA) and tracheo-esophageal fistula (TEF) with survival now exceeding 90%. The standard open approach to EA and distal TEF has been well described and essentially unchanged in last 60 years. Improved survival in recent decades is most attributable to advances in neonatal surgical techniques, anaesthesia and perioperative care. In a prospective randomized trial, we analysed the effect of pleural flap wrap around the anastomosis and post-operative elective ventilation support for 48 hours as main strategies towards improving the outcome in such patients.Methods: Twenty five neonates who were diagnosed as a case on tracheo-esophageal fistula (TEF) on clinical and radiological basis were selected for the study. All babies were more than 2kg weight and were operated within first two days of life after optimization. There was no evidence of any congenital heart disease or any other associated anomaly. In all patients primary esophageal anastomosis was possible which was subsequently covered by pleural flap wrap. All the patients were put post-operatively on ventilator electively for 48 hours. Contrast study was done on post-operative day five and feeding was started subsequently.Results: Postoperative surgical outcome was very good. Out of twenty five cases, 24 patients survived and only one baby died secondary to anastomotic leak and sepsis. Twenty three babies were discharged on post-operative day 8. One baby was on ventilator for 6 days and discharged on postoperative day 15. All patients are on regular follow up.Conclusions: Surgical outcome in patients with esophageal atresia and tracheo-esophageal fistula in neonates can be improved with use of pleural flap wrap and elective post-operative ventilation.

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Elective, postoperative ventilation in the management of esophageal atresia and tracheoesophageal fistula

Cited by 26 publications

References 17 publications

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

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

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

Strategies for optimizing surgical outcome in patients with esophageal atresia with tracheo-esophageal fistula

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