Evaluation of the intraoperative risk factors for esophageal anastomotic complications after primary repair of esophageal atresia with tracheoesophageal fistula

Okata, Yuichi; Murakami, Kosaku; Bitoh, Yuko; Mishima, Yasuhiko; Tamaki, Akihiko; Morita, Keiichi; Endo, Kazuhira; Hisamatsu, Chieko; Fukuzawa, Hiroaki; Yokoi, Akiko

doi:10.1007/s00383-016-3931-0

Cited by 47 publications

(53 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[16, 69] Despite the identification of several risk factors for such strictures, such as long-gap EA with consequent anastomotic tension, postoperative anastomotic leak, and GERD, both intra- and post-operative prevention strategies have failed to significantly decrease the incidence of these anastomotic strictures over time. [70] [71] [14]…”

Section: Anastomotic Stricturesmentioning

confidence: 99%

How to Care for Patients with EA-TEF: The Known and the Unknown

Mousa

Krishnan

Hassan

et al. 2017

Curr Gastroenterol Rep

View full text Add to dashboard Cite

EA patients are at high risk for gastroesophageal reflux and esophageal strictures, and the sequela that result. Extraintestinal manifestations of gastroesophageal reflux disease (GERD) can appear similar to other pathologic diagnoses commonly found in EA patients, such as congenital stricture, eosinophilic esophagitis, esophageal dysmotility, tracheomalacia, recurrent fistula, aspiration, etc. Therefore, it is important to have a standardized way to monitor for these issues. pH impedance allows for detection of nonacid reflux and the height of reflux, which are important in correlating symptoms with reflux episodes. A multidisciplinary approach is beneficial in evaluating and monitoring EA patients in the long term.

show abstract

Section: Anastomotic Stricturesmentioning

confidence: 99%

How to Care for Patients with EA-TEF: The Known and the Unknown

Mousa

Krishnan

Hassan

et al. 2017

Curr Gastroenterol Rep

View full text Add to dashboard Cite

show abstract

“…This changing may be attributed to several factors: improved neonatal care allows children to be in a better condition to survive early definitive surgery; moreover, increased understanding and specialized training of neonatal surgeons has made primary esophageal reconstruction achievable in most long-gap patients (13). A direct consequence of primary anastomosis in long-gap AE is anastomotic tension, which in turn contributes to AS, as widely reported in retrospective analysis (5–11). Nonetheless, with meticulous handling of the esophageal ends, preservation of the blood supply, and care to include the mucosa in each and every suture of the anastomosis, strictures can be kept to a minimum (24).…”

Section: Incidence and Risk Factorsmentioning

confidence: 83%

“…A relationship between stricture formation and prematurity or low birth weight, as well as VACTERL association, has been reported in retrospective cohorts (7, 8), but not confirmed in other series (5). The stricture rate seems to be unaffected by sex and intrauterine growth retardation (7).…”

Section: Incidence and Risk Factorsmentioning

confidence: 88%

“…The stricture rate seems to be unaffected by sex and intrauterine growth retardation (7). The role of tracheomalacia is controversial, since some authors reported its association with anastomotic complications (5), while others did not (7). …”

Section: Incidence and Risk Factorsmentioning

confidence: 99%

“…Anastomotic strictures (ASs) are still the main complication after repair of EA in neonates (3, 4). Despite the identification of multiple risk factors for ASs, such as long-gap EA with consequent anastomotic tension, postoperative anastomotic leak, and gastroesophageal reflux disease (GERD) (3, 5–11), prevention strategies with intraoperative techniques and/or postoperative treatments have failed to decrease the incidence of ASs over time (12). Traction and growth surgical techniques are considered a good system to induce esophageal growth and elongation, therefore facilitating anastomosis with less tension (13).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Anastomotic Strictures after Esophageal Atresia Repair: Incidence, Investigations, and Management, Including Treatment of Refractory and Recurrent Strictures

et al. 2017

View full text Add to dashboard Cite

Improved surgical techniques, as well as preoperative and postoperative care, have dramatically changed survival of children with esophageal atresia (EA) over the last decades. Nowadays, we are increasingly seeing EA patients experiencing significant short- and long-term gastrointestinal morbidities. Anastomotic stricture (AS) is the most common complication following operative repair. An esophageal stricture is defined as an intrinsic luminal narrowing in a clinically symptomatic patient, but no symptoms are sensitive or specific enough to diagnose an AS. This review aims to provide a comprehensive view of AS in EA children. Given the lack of evidence-based data, we critically analyzed significant studies on children and adults, including comments on benign strictures with other etiologies. Despite there is no consensus about the goal of the luminal diameter based on the patient’s age, esophageal contrast study, and/or endoscopy are recommended to assess the degree of the narrowing. A high variability in incidence of ASs is reported in literature, depending on different definitions of AS and on a great number of pre-, intra-, and postoperative risk factor influencing the anastomosis outcome. The presence of a long gap between the two esophageal ends, with consequent anastomotic tension, is determinant for stricture formation and its response to treatment. The cornerstone of treatment is endoscopic dilation, whose primary aims are to achieve symptom relief, allow age-appropriate capacity for oral feeding, and reduce the risk of pulmonary aspiration. No clear advantage of either balloon or bougie dilator has been demonstrated; therefore, the choice is based on operator experience and comfort with the equipment. Retrospective evidences suggest that selective dilatations (performed only in symptomatic patients) results in significantly less number of dilatation sessions than routine dilations (performed to prevent symptoms) with equal long-term outcomes. The response to dilation treatment is variable, and some patients may experience recurrent and refractory ASs. Adjunctive treatments have been used, including local injection of steroids, topical application of mitomycin C, and esophageal stenting, but long-term studies are needed to prove their efficacy and safety. Stricture resection or esophageal replacement with an interposition graft remains options for AS refractory to conservative treatments.

show abstract

Current status of laparoscopic total gastrectomy

Kawaguchi

Shiraishi

Akaike

et al. 2018

Annals of Gastroent Surgery

View full text Add to dashboard Cite

In this article, the current state of laparoscopic total gastrectomy (LTG) was reviewed, focusing on lymph node dissection and reconstruction. Lymph node dissection in LTG is technically similar to that in laparoscopic distal gastrectomy for early gastric cancer; however, LTG for advanced gastric cancer requires extended lymph node dissections including splenic hilar lymph nodes. Although a recent randomized controlled trial clearly indicated no survival benefit in prophylactic splenectomy for lymph node dissection at the splenic hilum, some patients may receive prognostic benefit from adequate splenic hilar lymph node dissection. Considering reconstruction, there are two major esophagojejunostomy (EJS) techniques, using a circular stapler (CS) or using a linear stapler (LS). A few studies have shown that the LS method has fewer complications; however, almost all studies have reported that morbidity (such as anastomotic leakage and stricture) is not significantly different for the two methods. As for CS, we grouped various studies addressing complications in LTG into categories according to the insertion procedure of the anvil and the insertion site in the abdominal wall for the CS. We compared the rate of complications, particularly for leakage and stricture. The rate of anastomotic leakage and stricture was the lowest when inserting the CS from the upper left abdomen and was significantly the highest when inserting the CS from the midline umbilical. Scrupulous attention to EJS techniques is required by surgeons with a clear understanding of the advantages and disadvantages of each anastomotic device and approach.

show abstract

Evaluation of the intraoperative risk factors for esophageal anastomotic complications after primary repair of esophageal atresia with tracheoesophageal fistula

Abstract: Surgeons should carefully perform anastomosis under less tension to prevent anastomotic complications in the primary repair of EA/TEF.

Cited by 47 publications

References 19 publications

How to Care for Patients with EA-TEF: The Known and the Unknown

How to Care for Patients with EA-TEF: The Known and the Unknown

Anastomotic Strictures after Esophageal Atresia Repair: Incidence, Investigations, and Management, Including Treatment of Refractory and Recurrent Strictures

Current status of laparoscopic total gastrectomy

Contact Info

Product

Resources

About