A new technique of anastomosis to avoid stricture formation in oesophageal atresia.
Anastomotic stricture is a common problem following repair of oesophageal atresia (OA). We describe a technique of oesophageal anastomosis that may prevent this problem. A horizontal incision is placed on the anterior hemicircumference of the upper pouch approximately 0.5 cm proximal to its blind ending to raise a flap. A corresponding vertical incision is made at the open end of the lower pouch to spatulate it. The flap from the upper pouch is laid into the open V of the lower pouch. This creates a wide anastomosis, and the suture line is not restricted to one plane. In 11 cases of OA, oesophageal continuity was established with this technique over a period of 10 years. Only 1 child developed an anastomotic stricture, which responded to a single dilatation. Two patients required Nissen's fundoplication for a distal oesophageal stricture. In neither of the patients did the anastomosis become stenotic. The technique described here is simple and effective. A suture line is created that is long and not in a single plane. This minimises the risk of stricture formation.
Singh
S J
SJ
Department of Paediatric Surgery, New Children's Hospital, Westmead. Sydney, NSW, Australia.
Shun
A
A
D000714:Anastomosis, Surgical / Q000379:methods*; D002648:Child; D003251:Constriction, Pathologic; D004933:Esophageal Atresia / Q000601:surgery*; D004947:Esophagus / Q000473:pathology; D018662:Fundoplication; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013536:Suture Techniques