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A novel technique for risk calculation of anastomotic leakage after thoracoscopic repair for esophageal atresia with distal fistula.

van der Zee DC, Vieirra-Travassos D, de Jong JR, Tytgat SH - World J Surg (2008)

Bottom Line: Both groups were comparable, and there was a statistical significant difference in both length of the proximal esophagus (p < 0.023) and distance of carina to proximal esophagus (p < 0.022) in patients who did and did not leak postoperatively.There seems to be a tendency toward a shorter proximal esophagus in recent years that was not obvious earlier.The digital measurement of the length of the proximal esophagus (M < 7 mm) and distance of carina to proximal esophagus (M > 13.5 mm) with the use of PACS gives a good risk calculation for postoperative leakage.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery KE 04.140.5, University Medical Center, 85090, 3508 AB Utrecht, The Netherlands. d.c.vanderzee@umcutrecht.nl

ABSTRACT

Purpose: This study was designed to determine the risk of anastomotic leakage after thoracoscopic repair for esophageal atresia by digitally measuring the length of the proximal esophagus and distance of carina to proximal esophagus.

Methods: With the use of Picture Archiving and Communication System (PACS), the length of the proximal esophagus from the top of the first thoracic vertebra was measured on the preoperative chest x-ray, as well as the distance from the carina to the proximal esophagus. The chest x-rays of 27 neonates, born with esophageal atresia with distal fistula, were examined. Furthermore, the tapes from the procedures were reviewed. Statistical analysis was performed with the t test for equality of means by using SPSS 12.0.1 for Windows.

Results: Both groups were comparable, and there was a statistical significant difference in both length of the proximal esophagus (p < 0.023) and distance of carina to proximal esophagus (p < 0.022) in patients who did and did not leak postoperatively. There seems to be a tendency toward a shorter proximal esophagus in recent years that was not obvious earlier.

Conclusions: The digital measurement of the length of the proximal esophagus (M < 7 mm) and distance of carina to proximal esophagus (M > 13.5 mm) with the use of PACS gives a good risk calculation for postoperative leakage.

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(a) Preoperative chest x-ray displaying a short proximal esophagus in a child who experienced postoperative leakage. (b) Measurement of length proximal esophagus from top of first thoracic vertebra. (c) Measurement of distance carina to upper esophageal pouch
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Fig2: (a) Preoperative chest x-ray displaying a short proximal esophagus in a child who experienced postoperative leakage. (b) Measurement of length proximal esophagus from top of first thoracic vertebra. (c) Measurement of distance carina to upper esophageal pouch

Mentions: Although there was slight difference in demographics between the two groups, there was no statistical difference (Table 1). The length of the upper pouch in the whole group varied from 3.5 to 25 mm (Fig. 1). Four patients (15%) during this period experienced postoperative leakage. The length of the upper pouch in this group varied from 3.5 to 11.9 mm (Fig. 2). In this last patient, there was an extreme subglotic stenosis, allowing only tube No. 2. During the procedure, there was an accidental extubation, which required reintubation with help of the ENT specialist using a flexible endoscope. All leakages could be managed conservatively by thoracic drainage.Fig. 1


A novel technique for risk calculation of anastomotic leakage after thoracoscopic repair for esophageal atresia with distal fistula.

van der Zee DC, Vieirra-Travassos D, de Jong JR, Tytgat SH - World J Surg (2008)

(a) Preoperative chest x-ray displaying a short proximal esophagus in a child who experienced postoperative leakage. (b) Measurement of length proximal esophagus from top of first thoracic vertebra. (c) Measurement of distance carina to upper esophageal pouch
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2480506&req=5

Fig2: (a) Preoperative chest x-ray displaying a short proximal esophagus in a child who experienced postoperative leakage. (b) Measurement of length proximal esophagus from top of first thoracic vertebra. (c) Measurement of distance carina to upper esophageal pouch
Mentions: Although there was slight difference in demographics between the two groups, there was no statistical difference (Table 1). The length of the upper pouch in the whole group varied from 3.5 to 25 mm (Fig. 1). Four patients (15%) during this period experienced postoperative leakage. The length of the upper pouch in this group varied from 3.5 to 11.9 mm (Fig. 2). In this last patient, there was an extreme subglotic stenosis, allowing only tube No. 2. During the procedure, there was an accidental extubation, which required reintubation with help of the ENT specialist using a flexible endoscope. All leakages could be managed conservatively by thoracic drainage.Fig. 1

Bottom Line: Both groups were comparable, and there was a statistical significant difference in both length of the proximal esophagus (p < 0.023) and distance of carina to proximal esophagus (p < 0.022) in patients who did and did not leak postoperatively.There seems to be a tendency toward a shorter proximal esophagus in recent years that was not obvious earlier.The digital measurement of the length of the proximal esophagus (M < 7 mm) and distance of carina to proximal esophagus (M > 13.5 mm) with the use of PACS gives a good risk calculation for postoperative leakage.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery KE 04.140.5, University Medical Center, 85090, 3508 AB Utrecht, The Netherlands. d.c.vanderzee@umcutrecht.nl

ABSTRACT

Purpose: This study was designed to determine the risk of anastomotic leakage after thoracoscopic repair for esophageal atresia by digitally measuring the length of the proximal esophagus and distance of carina to proximal esophagus.

Methods: With the use of Picture Archiving and Communication System (PACS), the length of the proximal esophagus from the top of the first thoracic vertebra was measured on the preoperative chest x-ray, as well as the distance from the carina to the proximal esophagus. The chest x-rays of 27 neonates, born with esophageal atresia with distal fistula, were examined. Furthermore, the tapes from the procedures were reviewed. Statistical analysis was performed with the t test for equality of means by using SPSS 12.0.1 for Windows.

Results: Both groups were comparable, and there was a statistical significant difference in both length of the proximal esophagus (p < 0.023) and distance of carina to proximal esophagus (p < 0.022) in patients who did and did not leak postoperatively. There seems to be a tendency toward a shorter proximal esophagus in recent years that was not obvious earlier.

Conclusions: The digital measurement of the length of the proximal esophagus (M < 7 mm) and distance of carina to proximal esophagus (M > 13.5 mm) with the use of PACS gives a good risk calculation for postoperative leakage.

Show MeSH
Related in: MedlinePlus