Publication: Özofagus atrezisi ameliyatı sonrası anastomoz darlığı gelişimini etkileyen faktörler
Abstract
Önbilgi/Amaç: Anastomoz darlığı (AD) Özofagus atrezisi (ÖA) ameliyatından sonra en sık görülen komplikasyondur. Bu komplikasyon farklı serilerde % 17.7 ile % 50 arasında bildirilmiştir. Yazımızda ÖA ve distal trakeoözofageal fistül (TÖF) nedeniyle merkezimizde ameliyat olan hastalarda gelişen AD ve darlığa neden olabilecek faktörler değerlendirilmiştir. Yöntem: 12 yılda ameliyat olan 68 hastanın uzun dönem izlenebilen 39'u değerlendirilmiştir. 39 hastanın 34'ünde distal TÖF'lü Özofagus atrezisi vardı. Tüm hastalara erken primer anastomoz uygulanmıştır. Anastomoz darlığı genel anestezide floroskopi altında balon ile açılmıştır. İki ve daha fazla sayıda genişletme gerektiren hastalarda AD geliştiği kabul edilmiştir. Hastalarda AD ile anastomoz için kullanılan dikiş sayısı, anastomoz kaçağı (AK), gastroözofageal reflü (GÖR) ve iki parça arası uzaklık arasındaki ilişki irdelenmiştir. Bulgular: Değerlendirilen 34 hastanın 13'ünde AD gelişti. Bu hastalarda anastomozda kullanılan dikiş sayısı ile AD gelişimi arasında bir ilişki saptanmadı. AK gelişen dört hastanın üçünde AD gelişmesine karşın grup tümüyle değerlendirildiğinde AD ile AK arasında anlamlı bir ilişki saptanmadı. İki Özofagus parçası arası uzaklık ile AD arasında zayıf bir bağıntı bulundu. AK gelişen hastalar çıkarıldığında ise GÖR ile AD arasında ise anlamlı bir ilişki saptandı. Sonuç: ÖA ameliyatından sonra AD gelişimi bir çok faktörle ilişkili olabilir. Serimizde GÖR varlığı ile AD gelişimi arasında anlamlı bir ilişki saptandı. İki parça arası uzaklık ile AD arasında ise zayıf bir bağıntı bulundu.
Aim: Anastomotic stricture (AS) is the most common post-operative complication in patients with esophageal atresia. This complication is reported between 17.7 and 50% in different series. In this paper we evaluated the factors that may lead to AS in the postoperative period of esophageal atresia and distal tracheoesophageal fistula (TEF) patients. Method: Sixtyeight patients were operated for esophageal atresia in our institute in a period of twelve years. Thirtynine of these patients had a longterm followup. Thirtyfour of these 39 patients had esophageal atresia (EA) with a distal TEF. Patients underwent early primary anastomosis. AS was dilated with esophageal balloon dilators under fluoroscopic control under general anaesthesia. Narrowing that required two or more dilations was defined as AS. The relationship between AS and the number of stitches used for the anastomosis, anastomotic leak (AL), gastroesophageal reflux (GER) and the gap between the two segments was evaluated. Results: AS developed in 13 of 34 patients. No significant relationship was found between the number of stitches for the anastomosis and AS. AS was detected in three of four patients with AL, but again no significant relationship could be find between AL and AS if the whole group was considered. Only a mild correlation was found between the gap between the esophageal segments and AS. If patients with ALjtfSce excluded a significant relationship between gastroesophageal reflux (GER) and AS was demonstrated. Conclusion: AS is a common postoperative complication in patients with esophageal atresia. Different factors may lead to development of AS. In our series we detected a significant relationship between GER and AS and a mild correlation between gap and AS.
Aim: Anastomotic stricture (AS) is the most common post-operative complication in patients with esophageal atresia. This complication is reported between 17.7 and 50% in different series. In this paper we evaluated the factors that may lead to AS in the postoperative period of esophageal atresia and distal tracheoesophageal fistula (TEF) patients. Method: Sixtyeight patients were operated for esophageal atresia in our institute in a period of twelve years. Thirtynine of these patients had a longterm followup. Thirtyfour of these 39 patients had esophageal atresia (EA) with a distal TEF. Patients underwent early primary anastomosis. AS was dilated with esophageal balloon dilators under fluoroscopic control under general anaesthesia. Narrowing that required two or more dilations was defined as AS. The relationship between AS and the number of stitches used for the anastomosis, anastomotic leak (AL), gastroesophageal reflux (GER) and the gap between the two segments was evaluated. Results: AS developed in 13 of 34 patients. No significant relationship was found between the number of stitches for the anastomosis and AS. AS was detected in three of four patients with AL, but again no significant relationship could be find between AL and AS if the whole group was considered. Only a mild correlation was found between the gap between the esophageal segments and AS. If patients with ALjtfSce excluded a significant relationship between gastroesophageal reflux (GER) and AS was demonstrated. Conclusion: AS is a common postoperative complication in patients with esophageal atresia. Different factors may lead to development of AS. In our series we detected a significant relationship between GER and AS and a mild correlation between gap and AS.