title: Major anastomotic dehiscence after repair of esophageal atresia: conservative management or reoperation?
abstract: SUMMARY. The authors report a case of recurrent anastomotic dehiscence following surgical repair of type C esophageal atresia according to the Gross classification. Surgical repair was followed by a recurrence, which was successfully managed with conservative treatment. Esophageal atresia with fistulization of the lower pouch in a male newborn with the VACTER association was repaired with a high-tension single-layer anastomosis. On the fifth postoperative day, major anastomotic dehiscence (> 4 mm) was diagnosed. The breach was re-sutured and the anastomosis reinforced with fibrin glue, but dehiscence recurred again 4 days later. Surgery was deferred and the infant was treated conservatively with continued chest-tube drainage and total parenteral nutrition. After 43 days, complete closure of the anastomosis was documented. Even major anastomotic dehiscence can be successfully managed with conservative treatment (chest-tube drainage, suspension of oral feedings, total parenteral nutrition). If the patient is otherwise stable, we feel that this approach should be attempted even when major leakage is present.
authors.affiliation: Department of Pediatric Surgery, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy. c.durzo@katamail.com
authors.forename: C
authors.initials: C
authors.lastname: D'Urzo
authors.forename: V
authors.initials: V
authors.lastname: Buonuomo
authors.forename: G
authors.initials: G
authors.lastname: Rando
authors.forename: C
authors.initials: C
authors.lastname: Pintus
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D002404:Catheterization; D015505:Chest Tubes; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004933:Esophageal Atresia / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010289:Parenteral Nutrition, Total; D012008:Recurrence; D012086:Reoperation; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000628:therapy*; D013907:Thoracostomy / Q000295:instrumentation; D014014:Tissue Adhesives / Q000627:therapeutic use; D014138:Tracheoesophageal Fistula / Q000601:surgery
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives