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Esophageal atresia and tracheoesophageal fistula: Effect of pleural cover on anastomotic dehiscence

BACKGROUND: A significant number of esophageal atresia and tracheoesophageal fistula patients have long gaps and a high propensity to leak. Anastomotic leak in esophageal atresia is associated with a significant morbidity and mortality. AIM: In a prospective randomized trial, we analyzed the risk fa...

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Autores principales: Gupta, Money, Mahajan, J. K., Bawa, Monika, Rao, K. L. N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3119936/
https://www.ncbi.nlm.nih.gov/pubmed/21731231
http://dx.doi.org/10.4103/0971-9261.78130
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author Gupta, Money
Mahajan, J. K.
Bawa, Monika
Rao, K. L. N.
author_facet Gupta, Money
Mahajan, J. K.
Bawa, Monika
Rao, K. L. N.
author_sort Gupta, Money
collection PubMed
description BACKGROUND: A significant number of esophageal atresia and tracheoesophageal fistula patients have long gaps and a high propensity to leak. Anastomotic leak in esophageal atresia is associated with a significant morbidity and mortality. AIM: In a prospective randomized trial, we analyzed the risk factors leading to anastomotic dehiscence and studied the effect of pleural wrap as an additional vascular cover around the esophageal anastomosis. MATERIALS AND METHODS: Forty patients were divided into two groups A and B randomly. In 20 patients of group A, pleural wrap was utilized for covering the anastomosis and in 20 patients of group B, no such wrap was utilized. RESULTS: Both the groups were comparable regarding age, sex, weight, gap length, tension at anastomosis and the hospital stay. The overall leak rate was 25% (10/40) in both the groups. The leak rate was not significantly different in two groups whenever a gap length was less than 2 cm or more than 3 cm. However, for a gap length of 2–3 cm, the leak rate in group A was 18% (2/11) and in group B was 50% (4/8) (P = 0.05). Thirty percent (3/10) of patients, whose anastomosis was under tension, leaked in group A as compared to 75% (6/8) in group B patients (P = 0.001). CONCLUSIONS: Use of pleural wrap was associated with less anastomotic dehiscence in patients with moderate gap esophageal atresia (2–3 cm) especially when the anastomosis was under tension.
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spelling pubmed-31199362011-06-30 Esophageal atresia and tracheoesophageal fistula: Effect of pleural cover on anastomotic dehiscence Gupta, Money Mahajan, J. K. Bawa, Monika Rao, K. L. N. J Indian Assoc Pediatr Surg Original Article BACKGROUND: A significant number of esophageal atresia and tracheoesophageal fistula patients have long gaps and a high propensity to leak. Anastomotic leak in esophageal atresia is associated with a significant morbidity and mortality. AIM: In a prospective randomized trial, we analyzed the risk factors leading to anastomotic dehiscence and studied the effect of pleural wrap as an additional vascular cover around the esophageal anastomosis. MATERIALS AND METHODS: Forty patients were divided into two groups A and B randomly. In 20 patients of group A, pleural wrap was utilized for covering the anastomosis and in 20 patients of group B, no such wrap was utilized. RESULTS: Both the groups were comparable regarding age, sex, weight, gap length, tension at anastomosis and the hospital stay. The overall leak rate was 25% (10/40) in both the groups. The leak rate was not significantly different in two groups whenever a gap length was less than 2 cm or more than 3 cm. However, for a gap length of 2–3 cm, the leak rate in group A was 18% (2/11) and in group B was 50% (4/8) (P = 0.05). Thirty percent (3/10) of patients, whose anastomosis was under tension, leaked in group A as compared to 75% (6/8) in group B patients (P = 0.001). CONCLUSIONS: Use of pleural wrap was associated with less anastomotic dehiscence in patients with moderate gap esophageal atresia (2–3 cm) especially when the anastomosis was under tension. Medknow Publications 2011 /pmc/articles/PMC3119936/ /pubmed/21731231 http://dx.doi.org/10.4103/0971-9261.78130 Text en Copyright: © Journal of Indian Association of Pediatric Surgeons http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Gupta, Money
Mahajan, J. K.
Bawa, Monika
Rao, K. L. N.
Esophageal atresia and tracheoesophageal fistula: Effect of pleural cover on anastomotic dehiscence
title Esophageal atresia and tracheoesophageal fistula: Effect of pleural cover on anastomotic dehiscence
title_full Esophageal atresia and tracheoesophageal fistula: Effect of pleural cover on anastomotic dehiscence
title_fullStr Esophageal atresia and tracheoesophageal fistula: Effect of pleural cover on anastomotic dehiscence
title_full_unstemmed Esophageal atresia and tracheoesophageal fistula: Effect of pleural cover on anastomotic dehiscence
title_short Esophageal atresia and tracheoesophageal fistula: Effect of pleural cover on anastomotic dehiscence
title_sort esophageal atresia and tracheoesophageal fistula: effect of pleural cover on anastomotic dehiscence
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3119936/
https://www.ncbi.nlm.nih.gov/pubmed/21731231
http://dx.doi.org/10.4103/0971-9261.78130
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