Technical innovations to reduce complication rates in esophageal atresia with particular reference to long-term outcomes: A single surgeon's experience of 22 years
Background: Following esophageal atresia/tracheoesophageal fistula (EA/TEF) repair, the standard leak rate reported in the literature is 5%–10%, and stricture rate is 40%–72%. There is a global quest for surgical innovations to drive down these complication rates which can cause considerable morbidi...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2022-01-01
|
| Series: | Journal of Indian Association of Pediatric Surgeons |
| Subjects: | |
| Online Access: | http://www.jiaps.com/article.asp?issn=0971-9261;year=2022;volume=27;issue=6;spage=728;epage=734;aulast=Morsi |
| _version_ | 1811199807688015872 |
|---|---|
| author | Ahmed Morsi Devesh Misra |
| author_facet | Ahmed Morsi Devesh Misra |
| author_sort | Ahmed Morsi |
| collection | DOAJ |
| description | Background: Following esophageal atresia/tracheoesophageal fistula (EA/TEF) repair, the standard leak rate reported in the literature is 5%–10%, and stricture rate is 40%–72%. There is a global quest for surgical innovations to drive down these complication rates which can cause considerable morbidity.
Methods: A prospectively maintained database of the senior author's patients who had esophageal atresia repair from 1995 to 2016 was reviewed. Two distinct innovations were implemented: (1) adequate or generous mobilization of the lower esophageal pouch and (2) a 2–5 mm slit in distal esophagus to widen its circumference.
Results: Forty-three patients with EA/TEF were reviewed. Of those, 40 underwent primary repair. The median follow-up was 12.5 years (range 4–26 years). There were no anastomotic leaks and only 8 (20%) patients developed anastomotic strictures requiring dilations (1–5 dilations/patients). One patient (2.5%) had a recurrent fistula. One early mortality was recorded. At the latest follow-up, 35 (87.5%) patients had normal oral feeding, while 1 (2.5%) patient had occasional food sticking episodes. Four syndromic patients (10%) were on jejunal or gastrostomy feeding.
Conclusion: An adequate or generous mobilization of the distal esophageal pouch, together with a 2–5 mm slit in the distal esophagus, achieves a tension-free and wide anastomosis. All anastomoses eventually narrow, sometimes just a little, and starting on a higher scale with a small slit, helps. These seemingly minor innovations, when used together, contributed to a substantially lower complication rate sustained over a 22-year period – no leaks and only 20% stricture rate. |
| first_indexed | 2024-04-12T01:54:44Z |
| format | Article |
| id | doaj.art-5ef7b7cc88f2460ca66ba7f53156bd3d |
| institution | Directory Open Access Journal |
| issn | 0971-9261 1998-3891 |
| language | English |
| last_indexed | 2024-04-12T01:54:44Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Indian Association of Pediatric Surgeons |
| spelling | doaj.art-5ef7b7cc88f2460ca66ba7f53156bd3d2022-12-22T03:52:50ZengWolters Kluwer Medknow PublicationsJournal of Indian Association of Pediatric Surgeons0971-92611998-38912022-01-0127672873410.4103/jiaps.jiaps_61_22Technical innovations to reduce complication rates in esophageal atresia with particular reference to long-term outcomes: A single surgeon's experience of 22 yearsAhmed MorsiDevesh MisraBackground: Following esophageal atresia/tracheoesophageal fistula (EA/TEF) repair, the standard leak rate reported in the literature is 5%–10%, and stricture rate is 40%–72%. There is a global quest for surgical innovations to drive down these complication rates which can cause considerable morbidity. Methods: A prospectively maintained database of the senior author's patients who had esophageal atresia repair from 1995 to 2016 was reviewed. Two distinct innovations were implemented: (1) adequate or generous mobilization of the lower esophageal pouch and (2) a 2–5 mm slit in distal esophagus to widen its circumference. Results: Forty-three patients with EA/TEF were reviewed. Of those, 40 underwent primary repair. The median follow-up was 12.5 years (range 4–26 years). There were no anastomotic leaks and only 8 (20%) patients developed anastomotic strictures requiring dilations (1–5 dilations/patients). One patient (2.5%) had a recurrent fistula. One early mortality was recorded. At the latest follow-up, 35 (87.5%) patients had normal oral feeding, while 1 (2.5%) patient had occasional food sticking episodes. Four syndromic patients (10%) were on jejunal or gastrostomy feeding. Conclusion: An adequate or generous mobilization of the distal esophageal pouch, together with a 2–5 mm slit in the distal esophagus, achieves a tension-free and wide anastomosis. All anastomoses eventually narrow, sometimes just a little, and starting on a higher scale with a small slit, helps. These seemingly minor innovations, when used together, contributed to a substantially lower complication rate sustained over a 22-year period – no leaks and only 20% stricture rate.http://www.jiaps.com/article.asp?issn=0971-9261;year=2022;volume=27;issue=6;spage=728;epage=734;aulast=Morsiatresiaesophagealfistulaleakstricture |
| spellingShingle | Ahmed Morsi Devesh Misra Technical innovations to reduce complication rates in esophageal atresia with particular reference to long-term outcomes: A single surgeon's experience of 22 years Journal of Indian Association of Pediatric Surgeons atresia esophageal fistula leak stricture |
| title | Technical innovations to reduce complication rates in esophageal atresia with particular reference to long-term outcomes: A single surgeon's experience of 22 years |
| title_full | Technical innovations to reduce complication rates in esophageal atresia with particular reference to long-term outcomes: A single surgeon's experience of 22 years |
| title_fullStr | Technical innovations to reduce complication rates in esophageal atresia with particular reference to long-term outcomes: A single surgeon's experience of 22 years |
| title_full_unstemmed | Technical innovations to reduce complication rates in esophageal atresia with particular reference to long-term outcomes: A single surgeon's experience of 22 years |
| title_short | Technical innovations to reduce complication rates in esophageal atresia with particular reference to long-term outcomes: A single surgeon's experience of 22 years |
| title_sort | technical innovations to reduce complication rates in esophageal atresia with particular reference to long term outcomes a single surgeon s experience of 22 years |
| topic | atresia esophageal fistula leak stricture |
| url | http://www.jiaps.com/article.asp?issn=0971-9261;year=2022;volume=27;issue=6;spage=728;epage=734;aulast=Morsi |
| work_keys_str_mv | AT ahmedmorsi technicalinnovationstoreducecomplicationratesinesophagealatresiawithparticularreferencetolongtermoutcomesasinglesurgeonsexperienceof22years AT deveshmisra technicalinnovationstoreducecomplicationratesinesophagealatresiawithparticularreferencetolongtermoutcomesasinglesurgeonsexperienceof22years |