A New Approach to Tense End-to-End Anostomosis in Primary Surgical Repair of Esophageal Atresia: Vascularized Pleural Flap

Background: Persistence or recurrence of stenosis is a complication of initial coarctation repair. This study aims to report short-term outcomes of surgical management of recurrent coarctation and initial repair analysis. Methods: We retrospectively reviewed our experience with 51 patients undergoing recoarctation surgical repair between 2008 and 2019 using antegrade cerebral perfusion technique. Results: Surgical correction included prosthetic patch aortoplasty in 23 (45%), resection with wide end-to-end anastomosis in 15 (29%) and a tube interposition graft in 13 (25%) patients. Median age at initial correction and reintervention were 12 month and 9 years. Median interval from primary repair to reintervention was 60 months. Initial repair analysis revealed 33% of patients had initial correction in the neonatal period, 72,5% of patients were done via a left thoracotomy approach and 63% of patients had end-to-end anastomosis at initial surgery. Conclusion: Our study demonstrates that surgical repair of recurrent coarctation of the aorta using antegrade cerebral perfusion technique can be performed safely and with excellent results.

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OPEN SURGICAL REPAIR OF CONGENITAL ESOPHAGEAL ATRESIA AND TRACHEOESOPHAGEAL FISTULA BY AZYGOS SPRING VERSUS CLASSIC REPAIR

Zagazig University Medical Journal ◽

10.21608/zumj.2019.30941 ◽

2019 ◽

Vol 25 (3) ◽

pp. 369-375

Author(s):

Wesam Mohamed Ali Amr ◽

Osama Hassan Ghareb ◽

Wael Mohamed Elshahat ◽

Abdulsalam Meftah Ali Elrabie

Keyword(s):

Esophageal Atresia ◽

Tracheoesophageal Fistula ◽

Surgical Repair ◽

Open Surgical Repair ◽

Congenital Esophageal Atresia

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Anastomotic Stricture in End-to-End Anastomosis—Risk Factors in a Series of 261 Patients with Esophageal Atresia

European Journal of Pediatric Surgery ◽

10.1055/s-0041-1739422 ◽

2021 ◽

Author(s):

Antti Koivusalo ◽

Annika Mutanen ◽

Janne Suominen ◽

Mikko Pakarinen

Keyword(s):

Risk Factors ◽

Anastomotic Leakage ◽

Esophageal Atresia ◽

Antireflux Surgery ◽

Anastomotic Stricture ◽

Revisional Surgery ◽

Type A ◽

Primary Reconstruction ◽

Anastomotic Breakdown ◽

End To End

Abstract Aim To assess the risk factors for anastomotic stricture (AS) in end-to-end anastomosis (EEA) in patients with esophageal atresia (EA). Methods With ethical consent, hospital records of 341 EA patients from 1980 to 2020 were reviewed. Patients with less than 3 months survival (n = 30) with Gross type E EA (n = 24) and with primary reconstruction (n = 21) were excluded. Outcome measures were revisional surgery for anastomotic stricture (RSAS) and number of dilatations required for anastomotic patency without RSAS. The factors that were tested for risk of RSAS or dilatations were distal tracheoesophageal fistula (TEF) at the carina in C-type EA (congenital TEF [CTEF]), type A/B EA, antireflux surgery (ARS), anastomotic leakage, recurrent TEF, and Spitz group and congenital heart disease. Main Results A total of 266 patients, Gross type A (n = 17), B (n = 3), C (n = 237), or D (n = 9) underwent EEA (early n = 240, delayed n = 26). Early anastomotic breakdown required secondary reconstruction in five patients. Of the remaining 261 patients, 17 (6.1%) had RSAS, whereas 244 patients with intact end to end required a median of five (interquartile range: 2–8) dilatations for anastomotic patency. Main risk factors for RSAS or (> 8) dilatations were CTEF, type A/B, ARS, and anastomotic leakage that increased the risk of RSAS or dilatations from 4.6- to 11-fold. Conclusion The risk of severe AS is associated with long-gap EA, significant gastroesophageal reflux, and anastomotic leakage.

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