The role of prophylactic chest drainage in the operative management of esophageal atresia with tracheoesophageal fistula.
BACKGROUND
Anastomotic leakage and respiratory complications are among the most common and potentially life-threatening complications following the surgical repair of esophageal atresia. Controversies exist regarding the efficacy of prophylactic extrapleural chest tube (EPCT) drainage in patients who have undergone repair of esophageal atresia.


METHODS
In this prospective study, 50 newborns with esophageal atresia and distal tracheoesophageal fistula (EA-DTEF) were randomized into two groups, with no significant differences regarding gender ratio, birth body weight and delivery status. Group 1 (n = 29) underwent a right thoracotomy and a single-stage extrapleural esophageal anastomosis. Group 2 (n = 21) received additionally an intraoperative EPCT next to the anastomosis. These groups were then compared with regard to postoperative respiratory complications (such as respiratory distress, pneumonia, pneumothorax, lung collapse, and apnea), anastomotic leakage, need for mechanical ventilation, time on mechanical ventilation, and outcome. Statistical analyses were performed with Mann-Whitney U test, Fisher's exact test, and binary logistic regression analysis.


RESULTS
The rates of respiratory complications and anastomotic leakage, need for mechanical ventilation, time on mechanical ventilation, and mortality rate were comparable between the two groups (P > 0.05). Mortality was associated with respiratory complications (P = 0.003) and anastomotic leakage (P = 0.007).


CONCLUSIONS
It seems that prophylactic EPCT drainage does not decrease the early postoperative respiratory complications and mortality rates in newborns with EA-DTEF.
Aslanabadi
Saeid
S
Pediatrics Research Center, Children Hospital, Tabriz University (Medical Sciences), Tabriz, Iran.
Jamshidi
Masoud
M
Tubbs
R Shane
RS
Shoja
Mohammadali Mohajel
MM
D000714:Anastomosis, Surgical / Q000379:methods; D015505:Chest Tubes; D004322:Drainage / Q000295:instrumentation*; D004933:Esophageal Atresia / Q000150:complications / Q000601:surgery*; D004947:Esophagus / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008171:Lung Diseases / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D014132:Trachea / Q000601:surgery; D014138:Tracheoesophageal Fistula / Q000150:complications / Q000601:surgery*