Postoperative Complications and Functional Outcome after Esophageal Atresia Repair: Results from Longitudinal Single-Center Follow-Up

Friedmacher, Florian; Kroneis, Birgit; Huber-Zeyringer, Andrea; Schöber, Peter; Till, Holger; Sauer, H.; Höllwarth, Michael E.

doi:10.1007/s11605-017-3423-0

Cited by 81 publications

(62 citation statements)

References 48 publications

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“…Sixty‐nine percent of the patients had minor and/or major cardiac abnormalities and 41% had pulmonary abnormalities, which percentages correspond with previous reports . Theoretically, cardiac malformations could have a large influence on the perioperative course.…”

Section: Discussionsupporting

confidence: 88%

“…com] percentages correspond with previous reports. [25][26][27][28] Theoretically, cardiac malformations could have a large influence on the perioperative course. However, as only five patients had major cardiac abnormalities, of whom one had a cyanotic malformation (see Supporting information Table S1), and regression analyses did not show major effects of minor and major cardiac malformations on outcome (Table 4), we judged it valid to keep their data in the analyses.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative management of esophageal atresia/tracheo‐esophageal fistula: An analysis of data of 101 consecutive patients

Hoorn

Costerus

Lau

et al. 2019

Pediatric Anesthesia

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Background The perioperative management of esophageal atresia/tracheo‐esophageal fistula by open or thoracoscopic approach can be complicated by metabolic derangements. Little is known, however, about the severity of derangements of vital and metabolic parameters in the perioperative period. Aim The aim of this study is to describe the perioperative courses of vital and metabolic parameters in 101 consecutive neonates undergoing surgical repair of esophageal atresia type C. Method In a retrospective cohort study, we extracted all data from the electronic anesthetic and medical charts of patients who underwent esophageal atresia type C repair within 30 days of life (2007‐2017). We distinguished three types of surgery: primary open, primary thoracoscopic, and primary thoracoscopic surgery converted to open surgery. Descriptive analysis was applied. Results The charts of 117 patients were reviewed: data of 101 were included. The perioperative anesthetic management was not standardized; various methods and medications were used for anesthesia induction and maintenance. Intraoperative blood gas analysis data of 72 patients were available and showed derangements regardless of type of surgery. The median pH‐value decreased to 7.21 [IQR 7.14‐7.30] and a pH‐value below 7.20 was found in 29 patients; in four cases below 7.0, with the lowest value 6.83. The median PaCO2 reached an upper level of 7.5kPa [IQR 5.8‐9.2]; in 13 cases above 10.0kPa, with a peak value of 25.8kPa. These high PaCO2 levels fluctuated with lowest measured PaCO2 of median 5.6 [IQR 4.5‐6.6], with the lowest value 2.8kPa. The median PaO2 level reached an upper level of 16.9kPa [IQR 11.8‐25.7], in 22 cases above 20.0kPa, with a peak value of 50.0kPa. These high levels fluctuated with lowest measured PaO2 levels of median 8.3kPa [IQR 6.73‐10.5]; the lowest PaO2 value was 4.7 kPa. Conclusion Open and thoracoscopic correction of esophageal atresia were associated with periods of severe metabolic derangements. These events need to be taken into account for the evaluation of esophageal atresia (surgical) care and in evaluations of short‐ and long‐term outcomes.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Perioperative management of esophageal atresia/tracheo‐esophageal fistula: An analysis of data of 101 consecutive patients

Hoorn

Costerus

Lau

et al. 2019

Pediatric Anesthesia

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“…Postoperative Komplikationen traten in 62 % der Fälle ein, dies waren Strikturen, welche einer operativen Versorgung bedurften (43 %), Anastomosenleckagen (18 %), rezidivierende Fisteln (5 %), Paralysen bzw. Paresen des Stimmapparates (5 %) und Dehiszenzen des Ösophagus (2 %) [55] In einer longitudinalen single-center Studie aus Österreich lag die Mortalität bei 4,2 % [83], Daten vom Gesundheitsministerium aus Italien aus dem Jahr 2012 berichten über eine Mortalitätsrate von 9,2 % [56]. In einer publizierten Arbeit aus Israel lag die Mortalität bei 13,4 % .…”

Section: Prognose Und Nachsorgeunclassified

Die Ösophagusatresie – von der Herausforderung in der Pränatalmedizin bis zur chirurgischen Versorgung

Jurk

Lacher²,

Springer

2019

Z Geburtshilfe Neonatol

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ZusammenfassungBei der Ösophagusatresie kommt es zu einer Hemmungsfehlbildung der Speiseröhre mit oder ohne Verbindung zur angrenzenden Trachea. Eine pränatale Diagnostik mittels Ultraschalluntersuchungen ist durch die indirekten Hinweiszeichen relativ unspezifisch und nur als eine Verdachtsdiagnose möglich. Neben dem gleichzeitigen Vorliegen eines Polyhydramnions sowie der wiederholt nicht möglichen Darstellung einer Magenblase, bzw. zu kleiner Magenblase, bestärkt das Vorliegen eines sog. „Pouch-sign“ die Verdachtsdiagnose. Eine MRT erhöht die pränatale Detektionsrate. Aufgrund der fehlenden sicheren sonografischen Marker, neben der möglichen direkten Darstellung des Ösophagus, sollten Ultraschallkontrollen in der Schwangerschaft durchgeführt werden. Insbesondere sollten kategorisch weitere mögliche Ursachen eine Polyhydramnions ausgeschlossen werden. Postnatal fallen die Kinder mit der klassischen Symptomatik auf. Die operative Versorgung ermöglicht den Betroffenen eine sehr gute Lebensqualität und Prognose. Eine lebenslange Observation und Begleitung ist notwendig.

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“…Nevertheless the prevalence of gastroesophageal reflux after replacement of the esophagus is much higher [6,7,8,9,10] as well as anastomotic leak, stricture and respiratory problems [11]. …”

Section: Abstract: Long-gap Esophageal Atresia Multistage Treatmentmentioning

confidence: 99%

“…The controversy is mostly based on severity and variety of complications of the anastomosis [5,8,10,11]. In our department, we perform an anastomosis of the native esophagus after patient-adapted elongation therapy avoiding gastric pull-up and colonic interposition.…”

mentioning

confidence: 99%

Our experience of secondary multistage treatment for complex long gap esophageal atresia

Sterlin¹,

Sochaczewski²,

Fotache³

et al. 2017

Medical news of the North Caucasus

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. In our department, we perform an anastomosis of the native esophagus after patient-adapted elongation therapy avoiding gastric pull-up and colonic interposition.The aim of study was to investigation of challenges and results of our approach lengthening procedure in children with long-gap esophageal atresia.Material and Methods. Five children with CLGEA (≥5 vertebral bodies gap) were referred to our department in 2016. All patients had been operated on previously at outside facilities. All children were admitted to our department with esophagostomy and gastrostomy after having anastomotic insufficiency and/or esophageal-(in two cases) or colonic interponate necrosis (in one case). As one of our major goals is to perform an anastomosis of the native esophagus, we used a Foker-technique [1,2] (Fig. 1) using traction sutures to lengthen the esophageal pouches within days and multistaged extrathoracic esophageal elongation described by Kimura [2] (Fig. 2), to solve the long gap problem and make a primary repair possible.Outcome variables included number and type of interventions, stenosis and anastomotic leak rates, number of dilatations, time to oral feeding, postanastomotic weight gain, and other complications. Currently, there is no uniform consensus in treatment of complex long-gap esophageal atresia (CLGEA). In our department, we perform an anastomosis of the native esophagus after patient-adapted elongation therapy by esophageal traction. This study describes results, challenges, and complications of our approach.

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Postoperative Complications and Functional Outcome after Esophageal Atresia Repair: Results from Longitudinal Single-Center Follow-Up

Abstract: Postoperative complications after EA/TEF repair are common and should be expertly managed to reduce the risk of long-term morbidity. Regular multidisciplinary surveillance with transitional care into adulthood is recommended in all patients with EA/TEF.

Cited by 81 publications

References 48 publications

Perioperative management of esophageal atresia/tracheo‐esophageal fistula: An analysis of data of 101 consecutive patients

Perioperative management of esophageal atresia/tracheo‐esophageal fistula: An analysis of data of 101 consecutive patients

Die Ösophagusatresie – von der Herausforderung in der Pränatalmedizin bis zur chirurgischen Versorgung

Our experience of secondary multistage treatment for complex long gap esophageal atresia

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