Anastomotic leakage in oesophageal atresia. Diagnostic and therapeutic considerations.

Oesophageal anastomotic leakage complicates 5-38% of operations performed for congenital atresia, and continues with prematurity and concomitant anomalies to be a cause of a fatal outcome. After a short review of the diagnostic and therapeutic possibilities of this complication the authors present their own series of 37 consecutive oesophageal atresia and/or oesophagotracheal fistula. Seven of these had anastomotic leakage within 2 to 8 days after operation. Three of them had been primarily operated on through a retropleural approach. The remaining four had had a transpleural approach and were all treated with an immediate rethoracotomy and resuture of the disruption with good primary results. A few cases reported earlier and the authors' present experience support the view that rethoracotomy and resuture of the disruption in transpleurally operated patients provides a method which allows early debridement of the pleural cavity and pulmonary reexpansion, accelerates secondary anastomotic healing and shortens the period needed for pleural drainage and intravenous nutrition.