Oesophageal atresia: paralysis and ventilation in management of the wide gap

MacKinlay, Gordon A.; Burtles, R.

doi:10.1007/bf00173597

Cited by 24 publications

(14 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We found that elective mechanical ventilation is beneficial in reducing tension on the anastomosis in the early stage, by eliminating swallowing and maintaining the neck in a flexed position. 24 Our overall survival rate of 82.6% is by any standard quite acceptable and comparable to that of developed countries. 12,13,25 Among those who died, two in the group C category had associated life-threatening anomalies and could not be saved in any case.…”

Section: Discussionsupporting

confidence: 55%

Esophageal Atresia and Tracheoesophageal Fistula

et al. 1997

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 55%

Esophageal Atresia and Tracheoesophageal Fistula

et al. 1997

View full text Add to dashboard Cite

“…Methods to overcome a wide gap – Various manoeuvres have been proposed to overcome a wide gap but in our experience a very tense anastomosis can be achieved in most cases and if the infant is subsequently electively paralyzed and mechanically ventilated for approximately 5 days postoperatively, the anastomosis will heal without leakage [52,53]. Others have proposed tubularisation of the upper pouch after creating a flap [54], circular myotomy of the upper pouch [55] or abandoning any attempt at initial primary anastomosis awaiting delayed primary anastomosis 6–12 weeks later [56].…”

Section: Managementmentioning

confidence: 99%

Oesophageal atresia

Spitz

2007

Orphanet J Rare Dis

423

352

View full text Add to dashboard Cite

Oesophageal atresia (OA) encompasses a group of congenital anomalies comprising of an interruption of the continuity of the oesophagus with or without a persistent communication with the trachea. In 86% of cases there is a distal tracheooesophageal fistula, in 7% there is no fistulous connection, while in 4% there is a tracheooesophageal fistula without atresia. OA occurs in 1 in 2500 live births. Infants with OA are unable to swallow saliva and are noted to have excessive salivation requiring repeated suctioning. Associated anomalies occur in 50% of cases, the majority involving one or more of the VACTERL association (vertebral, anorectal, cardiac, tracheooesophageal, renal and limb defects). The aetiology is largely unknown and is likely to be multifactorial, however, various clues have been uncovered in animal experiments particularly defects in the expression of the gene Sonic hedgehog (Shh). The vast majority of cases are sporadic and the recurrence risk for siblings is 1%. The diagnosis may be suspected prenatally by a small or absent stomach bubble on antenatal ultrasound scan at around 18 weeks gestation. The likelihood of an atresia is increased by the presence of polyhydramnios. A nasogastric tube should be passed at birth in all infants born to a mother with polyhydramnios as well as to infants who are excessively mucusy soon after delivery to establish or refute the diagnosis. In OA the tube will not progress beyond 10 cm from the mouth (confirmation is by plain X-ray of the chest and abdomen). Definitive management comprises disconnection of the tracheooesophageal fistula, closure of the tracheal defect and primary anastomosis of the oesophagus. Where there is a "long gap" between the ends of the oesophagus, delayed primary repair should be attempted. Only very rarely will an oesophageal replacement be required. Survival is directly related to birth weight and to the presence of a major cardiac defect. Infants weighing over 1500 g and having no major cardiac problem should have a near 100% survival, while the presence of one of the risk factors reduces survival to 80% and further to 30-50% in the presence of both risk factors.

show abstract

“…Some years later, Mackinlay and Burtles 8 compared anastomotic complications in two consecutive series of 17 infants with oesophageal atresia and distal fistula. The second series differed from the first in several ways (Table 1), so that the two series were not strictly comparable.…”

Section: Review Of Evidencementioning

confidence: 99%

“…In one study, anastomotic leaks were observed to occur almost twice as often in patients with gastro‐oesophageal reflux than in those without 7 . More recently, the suggestion has been made that nonreversal of anaesthesia in the postoperative period and graded withdrawal of respiratory support is a further factor that may influence the rate of anastomotic leakage 2 , 8 . This overview examines the published scientific evidence on which this and subsequent claims have been made.…”

mentioning

confidence: 99%

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

Beasley

1999

J Paediatrics Child Health

View full text Add to dashboard Cite

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.

show abstract

Oesophageal atresia: paralysis and ventilation in management of the wide gap

Cited by 24 publications

References 8 publications

Esophageal Atresia and Tracheoesophageal Fistula

Esophageal Atresia and Tracheoesophageal Fistula

Oesophageal atresia

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

Contact Info

Product

Resources

About