Publication: İzole özofagus atrezisinde geciktirilmiş primer onarım: Ön sonuçlarımız
Abstract
İzole özofagus atrezi (ÖA) terinin tedavisinde hangi cerrahi yöntemin tercih edilmesi gerektiği halen tartışmalıdır. Geciktirilmiş primer onarım (GPO) uyguladığımız olgulardaki deneyimlerimizi irdeleyerek, bu yöntemin ülkemiz şartlarındaki uygulanabilirliğini ve güvenilirliğini değerlendirmeyi amaçladık. 1989-2000 yılları arasında beş izole ÖA olgusu izlendi ve bunlardan dördünde GPO yapıldı. Kalan bir olgu, ki bu serinin ilk olgusudur, evde ameliyat öncesi izlem esnasında aspirasyona bağlı olarak kaybedildi. Diğer olguların ameliyat sonrasında komplikasyonlar, beslenme şekli ve vücut ağırlığı artışları değerlendirildi. Tüm olgularda primer onarımın yapılması olanaklı oldu. Ameliyat anında yaşları 2.5-5 ay, poşlar arasındaki uzaklık da 3.5 - 4.5 vertebra boyu arasında değişiyordu. Bir olguda ameliyat esnasında proksimal fistül saptandı. Olguların tümünde anastomozun yapılabilmesi için değişik sayıda (1-3) Livaditis miyotomisi (LM) gerekti. Olguların tümünde ameliyat sonrası erken komplikasyonlar görüldü ancak tümü konservatif yöntemlere cevap verdi. İki ay -4.5 (ortalama 2.4) yıllık izlemde olgularımızın beslenme kaliteleri, özofagus peristaltizmleri, ÖA ve distal fistül nedeni ile opere edilenlerden farklı değildi. Bu küçük seri ile elde ettiğimiz sonuçlar ışığında, izole ÖA'ların tedavisinde tercih ettiğimiz yöntem bundan böyle de GPO olacaktır.
Repair of isolated esophageal atresia (EA) is still a challenging problem. We have reviewed our experience with delayed primary anastomosis by Livaditis myotomy (LM) to assess the efficacy, practicability and safety of this approach. From 1989 to 2000, five cases of long-gap isolated EA were admitted. Among these patients, four underwent DPR and remaining one (the first patient of this series) was lost pre-operatively due to aspiration. Postoperative complications, feeding pattern and weight gain were assessed. Primary anastomosis was possible in all patients during secondary operation. Their ages at operation were ranged between 2.5 to 5 months, and the gap was measured 3.5 to 4.5 vertebral bodies in length. A proximal fistula was demonstrated during surgery in one of the cases. LM in various number (1 to 3) was required to achieve a successful primary anastomosis in all patients. A proximal fistula was recognized during the operation in one of the patient. All patients had some early postoperative complications (stricture in all and leak in one). Anastomotic leak healed spontaneously. During the 2 months to 4.5 (mean 2.4) years of follow-up period, feeding quality, esophageal peristalsis and motility of the patients were comparable with those who had esophageal repair for EA and distal fistula. On the basis of our experience, DPR remains our treatment of choice for isolated atresia.
Repair of isolated esophageal atresia (EA) is still a challenging problem. We have reviewed our experience with delayed primary anastomosis by Livaditis myotomy (LM) to assess the efficacy, practicability and safety of this approach. From 1989 to 2000, five cases of long-gap isolated EA were admitted. Among these patients, four underwent DPR and remaining one (the first patient of this series) was lost pre-operatively due to aspiration. Postoperative complications, feeding pattern and weight gain were assessed. Primary anastomosis was possible in all patients during secondary operation. Their ages at operation were ranged between 2.5 to 5 months, and the gap was measured 3.5 to 4.5 vertebral bodies in length. A proximal fistula was demonstrated during surgery in one of the cases. LM in various number (1 to 3) was required to achieve a successful primary anastomosis in all patients. A proximal fistula was recognized during the operation in one of the patient. All patients had some early postoperative complications (stricture in all and leak in one). Anastomotic leak healed spontaneously. During the 2 months to 4.5 (mean 2.4) years of follow-up period, feeding quality, esophageal peristalsis and motility of the patients were comparable with those who had esophageal repair for EA and distal fistula. On the basis of our experience, DPR remains our treatment of choice for isolated atresia.