Hemanshoo S Thakkar1, Joseph Cooney2, Neetu Kumar2, Edward Kiely2. 1. Division of Paediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK. Electronic address: hemanshoo@gmail.com. 2. Division of Paediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK.
Abstract
AIMS: Oesophageal atresia (OA) with or without tracheoesophageal fistula (TOF) is the most common congenital anomaly of the oesophagus. There is limited literature suggesting a linear relationship between increasing gap length and the incidence of all major complications. We sought to assess whether measured gap length at the time of surgery was related to outcomes in our patients. METHODS: All patients with a diagnosis of OA +/- TOF who underwent repair under a single surgeon between 1983 and 2012 were included. The length between the oesophageal pouches was measured at the time of surgery. Patients were then divided into three groups; short ≤1cm, intermediate >1-≤2cm and long >2-≤5cm. Outcome measures were anastomotic leak, strictures requiring dilatation, gastrooesophageal reflux disease (GORD) and need for fundoplication. RESULTS: 122 patients were included in the study. The outcomes for patients with short (n=53), intermediate (n=51) and long gaps (n=18) were as follows: anastomotic leak - 1.9%, 2%, 5.5% (P=0.66), strictures requiring dilatation - 32%, 33%, 50% (P=0.67), GORD - 51%, 59%, 72% (P=0.58) and need for fundoplication - 11%, 20%, 44% (*P=0.02). There were no deaths related to the repair. CONCLUSIONS: Measured gap length at the time of surgery did not have a linear relationship with leak or stricture rate. Our experience suggests that when primary repair is possible absolute gap length is irrelevant to the development of post-operative complications. There is however a significant increase in the need for fundoplication in those with a long gap.
AIMS: Oesophageal atresia (OA) with or without tracheoesophageal fistula (TOF) is the most common congenital anomaly of the oesophagus. There is limited literature suggesting a linear relationship between increasing gap length and the incidence of all major complications. We sought to assess whether measured gap length at the time of surgery was related to outcomes in our patients. METHODS: All patients with a diagnosis of OA +/- TOF who underwent repair under a single surgeon between 1983 and 2012 were included. The length between the oesophageal pouches was measured at the time of surgery. Patients were then divided into three groups; short ≤1cm, intermediate >1-≤2cm and long >2-≤5cm. Outcome measures were anastomotic leak, strictures requiring dilatation, gastrooesophageal reflux disease (GORD) and need for fundoplication. RESULTS: 122 patients were included in the study. The outcomes for patients with short (n=53), intermediate (n=51) and long gaps (n=18) were as follows: anastomotic leak - 1.9%, 2%, 5.5% (P=0.66), strictures requiring dilatation - 32%, 33%, 50% (P=0.67), GORD - 51%, 59%, 72% (P=0.58) and need for fundoplication - 11%, 20%, 44% (*P=0.02). There were no deaths related to the repair. CONCLUSIONS: Measured gap length at the time of surgery did not have a linear relationship with leak or stricture rate. Our experience suggests that when primary repair is possible absolute gap length is irrelevant to the development of post-operative complications. There is however a significant increase in the need for fundoplication in those with a long gap.
Authors: Augusto Zani; Giovanni Cobellis; Justyna Wolinska; Priscilla P L Chiu; Agostino Pierro Journal: Pediatr Surg Int Date: 2015-10-31 Impact factor: 1.827
Authors: H Thakkar; D M Mullassery; S Giuliani; S Blackburn; K Cross; J Curry; Paolo De Coppi Journal: Pediatr Surg Int Date: 2021-02-07 Impact factor: 1.827
Authors: Emma Svensson; Peter Zvara; Niels Qvist; Lars Hagander; Sören Möller; Lars Rasmussen; Henrik Daa Schrøder; Eva Kildall Hejbøl; Niels Bjørn; Súsanna Petersen; Kristine Cederstrøm Larsen; Jan Krhut; Oliver J Muensterer; Mark Bremholm Ellebæk Journal: Int J Surg Protoc Date: 2021-08-11