Effect of perioperative management of type III esophageal atresia on postoperative complications

Abstract

Objective To explore the influencing factors of perioperative management on complications after operations for congenital esophageal atresia (CEA) and thus lower the incidence of complications. Methods Clinical data were collected for 225 hospitalized CEA cases for 9 years. Chest and abdominal plain films, esophagectomy, chest computed tomography scan and three-dimensional reconstruction examination were performed after admission for clinical typing. The clinical types were I (n=3), Ⅲa (n=92), Ⅲb (n=126) and V (n=4). Among them, 206 patients underwent extraperitoneal repair of esophageal tracheal fistula and esophageal anastomosis while another 12 cases underwent thoracoscopy. The incidence of postoperative complications and the effects of operative duration and the time of oral feeling of milk on the incidence of postoperative complications were analyzed. Results Seventy-seven cases began enteral nutrition after 7 days and there were anastomotic stenosis (n=12) and anastomotic leakage (n=19); 21 cases began enteral nutrition within 7 days and there were anastomotic stenosis (n=2) and anastomotic leakage (n=7). And 161 cases accepted operation within 7 days and anastomotic leakage occurred in 26 cases; 57 cases accepted operation within 7 days and anastomotic leakage occurred in 20 cases. The durations of mechanical ventilation were 4.2±2.1 and 6.4±2.3 days respectively. Conclusions Strengthening perioperative management and early surgery may significantly reduce the incidence of anastomotic leakage and shorten the duration of postoperative mechanical ventilation. Physicians should have sufficient endoscopic experiences and strictly control indications. Key words: Esophageal atresia; Tracheoesophageal fistula; Perioperative management