title: Esophageal atresia and tracheoesophageal fistula: Effect of pleural cover on anastomotic dehiscence.
abstract: BACKGROUND
  A significant number of esophageal atresia and tracheoesophageal fistula patients have long gaps and a high propensity to leak. Anastomotic leak in esophageal atresia is associated with a significant morbidity and mortality.
  
  
  OBJECTIVE
  In a prospective randomized trial, we analyzed the risk factors leading to anastomotic dehiscence and studied the effect of pleural wrap as an additional vascular cover around the esophageal anastomosis.
  
  
  METHODS
  Forty patients were divided into two groups A and B randomly. In 20 patients of group A, pleural wrap was utilized for covering the anastomosis and in 20 patients of group B, no such wrap was utilized.
  
  
  RESULTS
  Both the groups were comparable regarding age, sex, weight, gap length, tension at anastomosis and the hospital stay. The overall leak rate was 25% (10/40) in both the groups. The leak rate was not significantly different in two groups whenever a gap length was less than 2 cm or more than 3 cm. However, for a gap length of 2-3 cm, the leak rate in group A was 18% (2/11) and in group B was 50% (4/8) (P = 0.05). Thirty percent (3/10) of patients, whose anastomosis was under tension, leaked in group A as compared to 75% (6/8) in group B patients (P = 0.001).
  
  
  CONCLUSIONS
  Use of pleural wrap was associated with less anastomotic dehiscence in patients with moderate gap esophageal atresia (2-3 cm) especially when the anastomosis was under tension.
authors: Department of Pediatric Surgery, Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors: Money
authors: M
authors: Gupta
authors: J K
authors: JK
authors: Mahajan
authors: Monika
authors: M
authors: Bawa
authors: K L N
authors: KL
authors: Rao