title: Efficacy of postoperative elective ventilatory support for leakage protection in primary anastomosis of congenital esophageal atresia.
abstract: Anastomotic complications after primary repair of congenital esophageal atresia (EA) are recognized and feared complications. A close association exists between anastomotic leakage and the tension of the anastomosis on the suture line. This study aimed to evaluate the efficacy of postoperative elective ventilation support (PEVS) under paralysis with neck flexion after primary repair of EA. Forty-two EA patients; 4 cases with type A and 38 with type C by Gross classification received primary or delayed primary anastomosis between 1979 and 2003. PEVS has been introduced in the postoperative management of all EA cases since 1998. Vecuronium bromide was administered together with fentanyl citrate for five postoperative days. Patients were retrospectively divided into two groups: with or without PEVS management. There was no difference in operation data such as gastrostomy construction, gap between esophageal upper and lower pouch, primary or delayed primary anastomosis. PEVS under paralysis with neck flexion reduced postoperative anastomotic leakages in primary anastomosis with or without a Livaditis procedure. PEVS did not adversely increase anastomotic stricture, atelectasis, severe gastro-esophageal reflux, prolong days on ventilatory support or decrease survival rate. PEVS is an effective management method to decrease anastomotic complications for EA neonates.
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie, 514-8507, Japan. ucchie@clin.medic.mie-u.ac.jp
authors.forename: Keiichi
authors.initials: K
authors.lastname: Uchida
authors.forename: Mikihiro
authors.initials: M
authors.lastname: Inoue
authors.forename: Kohei
authors.initials: K
authors.lastname: Otake
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Okita
authors.forename: Yuki
authors.initials: Y
authors.lastname: Morimoto
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Araki
authors.forename: Chikao
authors.initials: C
authors.lastname: Miki
authors.forename: Masato
authors.initials: M
authors.lastname: Kusunoki
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D016009:Chi-Square Distribution; D004933:Esophageal Atresia / Q000145:classification / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D011183:Postoperative Complications / Q000517:prevention & control*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014673:Vecuronium Bromide / Q000008:administration & dosage
chemical_list: D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide