Thoracoscopic approach for complications after esophageal atresia repair: initial experience

Novillo, I. Cano; Castro, Belén Aneiros; Lenz, J. Godoy; Rivera, Maria Consuela Puentes; Vázquez, Araceli García; Zegarra, Cecilia Moreno

doi:10.1111/ases.12714

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…Most anastomotic fistulas can be cured by conservative treatment, including total parenteral nutrition support or post-pyloric enteral nutrition support, pleural drainage and adequate antibiotic use [ 20 , 21 ]. Some scholars advocate early operations to close the fistula in order to avoid severe pulmonary infection and empyema [ 22 , 23 ]. Anastomotic fistula leads to severe anastomotic inflammation.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia

Huang

Hong

Chen

et al. 2021

J Cardiothorac Surg

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Background Oesophageal atresia is a congenital malformation of the oesophagus and a serious malformation of the digestive system, postoperative complications include acute respiratory failure, pneumonia, anastomotic fistula, anastomotic stenosis, tracheal stenosis, gastroesophageal reflux and eosinophilic oesophagitis, anastomotic fistula is one of the important causes of postoperative death. The objective of this study is to identify the risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia. Methods A retrospective analysis was performed on the clinical data of 107 children with congenital oesophageal atresia who underwent one-stage anastomosis in our hospital from January 2013 to December 2018. Single-factor and multivariate logistic regression analyses were performed to determine the risk factors for anastomotic fistula and anastomotic stenosis. Results A total of 107 children with oesophageal atresia underwent one-stage anastomosis, and the incidence of anastomotic fistula was 26.2%. The probability of anastomotic stenosis in the long term was 52.3%, and the incidence of refractory stenosis (dilation ≥5 times) was 13.1%. Analysis of the clinical count data in the anastomotic fistula group and non-anastomotic fistula group showed that preoperative albumin (F = 4.199, P = 0.043), low birth weight (F = 7.668, P = 0.007) and long gap defects (F = 6.107, P = 0.015) were risk factors for postoperative anastomotic fistula. Further multivariate logistic regression analysis showed that low birth weight (Wald2 = 4.499, P = 0.034, OR = 2.775) and long gap defects (Wald2 = 6.769, P = 0.009, OR = 4.939) were independent risk factors for postoperative anastomotic fistula. Premature delivery (F = 5.338, P = 0.023), anastomotic fistula (F = 11.381, P = 0.001), endoscopic surgery (F = 6.343, P = 0.013), preoperative neutrophil count (F = 8.602, P = 0.004), preoperative low albumin (F = 8.410, P = 0.005), and a preoperative prognostic nutritional index < 54 (F = 5.54, P = 0.02) were risk factors for refractory anastomotic stenosis in children. Further multivariate logistic regression analysis showed that postoperative anastomotic fistula (Wald2 = 11.417, P = 0.001, OR = 8.798), endoscopic surgery (Wald2 = 9.633, P = 0.002, OR = 4.808), and a prognostic nutritional index < 54 (Wald2 = 4.540, P = 0.002, OR = 2.3798) were independent risk factors for refractory anastomotic stenosis. Conclusion Low birth weight and long gap defects are important predictors of postoperative anastomotic fistula, and the possibility of refractory anastomotic stenosis should be considered. The long-term risk of anastomotic stenosis was increased in children undergoing endoscopic surgery and in those with a preoperative prognostic nutritional index < 54.

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Section: Discussionmentioning

confidence: 99%

Risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia

Huang

Hong

Chen

et al. 2021

J Cardiothorac Surg

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“…On contrary, some authors encourage thoracoscopic approach for better visualization and accurate dissection in surgical management of recTEF (24). Since thoracoscopic approach has several advantages, it should be kept in mind especially for the patients whose primary repair was also performed thoracoscopically.…”

Section: Management Of Rectefmentioning

confidence: 99%

Tracheoesophageal fistula after esophageal atresia repair: recurrent, missed or acquired

Boybeyi¹,

Soyer²

2022

Curr Chall Thorac Surg

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Esophageal atresia (EA) is a common congenital anomaly of pediatric surgical practice.Tracheoesophageal fistula (TEF) is defined as congenital fistulous connection between esophagus and airway.All newborns with EA need immediate surgical repair of this anomaly. As the survival has reached to 95%, the long-term consequences of TEF have become the focus of interest. The main complications of EA repair are classified as early complications including anastomotic leak, stricture, recurrent TEF (recTEF) and late complications including gastroesophageal reflux, esophageal dysmotility, tracheomalacia and respiratory disorders. TEFs seen after EA repair are the most challenging complication for both patient and the surgeon. These fistulas can occur after EA repair because of the recanalization of ligated original TEF called recTEF, a de novo fistula with different location called acquired TEF (acqTEF) or a second congenital fistula missed at the primary surgery called missed TEF (mTEF). Overall, incidence of fistula recurrence is between 5-10%. The well-described risk factors for TEF recurrences are inadequate ligation of original TEF, anastomotic complications including leak, stricture and ischemia, tracheal injuries at the primary repair, and juxtapositioning of esophageal and tracheal suture lines. The clinical presentation of all types of fistulas is similar. Thus, the diagnosis of all these fistulas is challenging. Even, all patients having coughing, chocking or recurrent respiratory tract infections after EA repair should be investigated for the presence of TEF recurrence. In addition, the management of each type of fistula requires different approaches and can be technically demanding for most cases. Although surgical management is mostly inevitable in the management of recTEF, medical observation may be a choice for the management of acqTEFs since there is a possibility of spontaneous healing. Despite the advanced surgical technique, the risk for secondary recurrences, increased morbidity and even mortality are still exists. Therefore, this review will focus on all of the aspects of TEFs seen after EA repair.

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“…Most anastomotic stulas can be cured by conservative treatment, including total parenteral nutrition support or post-pyloric enteral nutrition support, pleural drainage and adequate antibiotic use [19,20]. Some scholars advocate early operations to close the stula in order to avoid severe pulmonary infection and empyema [21,22]. Anastomotic stula leads to severe anastomotic in ammation.…”

Section: Risk Factor Analysis Of Long-term Anastomotic Stenosismentioning

confidence: 99%

Risk Factors for Anastomotic Complications After One-stage Anastomosis for Oesophageal Atresiarisk Factors for Anastomotic Complications After One-stage Anastomosis for Oesophageal Atresia

Huang¹,

Hong²,

Chen³

et al. 2020

Preprint

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Objective: The objective of this study is to identify the risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia.Methods: A retrospective analysis was performed on the clinical data of 107 children with congenital oesophageal atresia who underwent one-stage anastomosis in our hospital from January 2016 to December 2018. Single-factor and multivariate logistic regression analyses were performed to determine the risk factors for anastomotic fistula and anastomotic stenosis.Results: A total of 107 children with oesophageal atresia underwent one-stage anastomosis, and the incidence of anastomotic fistula was 26.2%. The probability of anastomotic stenosis in the long term was 52.3%, and the incidence of refractory stenosis (dilation ≥5 times) was 13.1%. Analysis of the clinical count data in the anastomotic fistula group and non-anastomotic fistula group showed that preoperative albumin (F=4.199, P=0.043), low birth weight (F=7.668, P=0.007) and long gap defects (F=6.107, P=0.015) were risk factors for postoperative anastomotic fistula. Further multivariate logistic regression analysis showed that low birth weight (Wald2=4.499, P =0.034, OR=2.775) and long gap defects (Wald2=6.769, P =0.009, OR=4.939) were independent risk factors for postoperative anastomotic fistula. Premature delivery (F=5.338, P=0.023), anastomotic fistula (F=11.381, P=0.001), endoscopic surgery (F=6.343, P=0.013), preoperative neutrophil count (F=8.602, P=0.004), preoperative low albumin (F=8.410, P=0.005), and a preoperative prognostic nutritional index < 54 (F=5.54, P=0.02) were risk factors for long-term anastomotic stenosis in children. Further multivariate logistic regression analysis showed that postoperative anastomotic fistula (Wald2=11.417, P =0.001, OR=8.798), endoscopic surgery (Wald2=9.633, P =0.002, OR=4.808), and a prognostic nutritional index < 54 (Wald2=4.540, P =0.002, OR=2.3798) were independent risk factors for long-term anastomotic stenosis.Conclusion: Low birth weight and long gap defects are important predictors of postoperative anastomotic fistula, and the possibility of long-term anastomotic stenosis should be considered. The long-term risk of anastomotic stenosis was increased in children undergoing endoscopic surgery and in those with a preoperative prognostic nutritional index < 54.

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Thoracoscopic approach for complications after esophageal atresia repair: initial experience

Cited by 5 publications

References 14 publications

Risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia

Risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia

Tracheoesophageal fistula after esophageal atresia repair: recurrent, missed or acquired

Risk Factors for Anastomotic Complications After One-stage Anastomosis for Oesophageal Atresiarisk Factors for Anastomotic Complications After One-stage Anastomosis for Oesophageal Atresia

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