| 摘要 |
Prupose: Th evaluate the effect of mobilization of the esophageal pouch up to mid-level of the neck, oblique cut end of esophageal stumps, and one-layer anastomosis using 6-0 absorbable sutures on reducing occurrence of anastomotic stricture.
MethodsL Mobilixation of the esophageal pouch up to mid-level of the neck, oblique cut end of esophageal stumps, and anastomosis using 6-0 absorbable sutures were conducted on 14 of 15 patients with congenital esophageal atresia and tracheoesphageal (TE) fistula. Of these 15 patients, 12 underwent primary repair, while three others were referred from other hospitals for further management of anastomotic stenosis alone (n=2) or combined with recurrent TE fistula (n=1). Two of these three referred patients underwent anastomotic revision and the other one underwent esophagojejunostomy, gastrojejunostomy, and jejunojejunostomy.
Results: All esophageal gaps up to 3 cm of these primary-repair patients could be easily approximated without myotomy after mobilixation of the esophageal pouch up to mid-level of the neck and all anastomoses were delicately done. None of these 12 primary-repair newborns required gastrostomy. Esophagography revealed that all anastomoses were patent, and the diameter of the proximal esophagus was comparable to that of the distal esophagus. One patient later died of heart surgery.
Among the three referred patients, the dilated proximal esophagi resulted from delayed treatment also gradually returned to normal.
Conclusion: Mobilization of the esophageal pouch to mid-level of the neck, oblique cut end of esophageal stumps, and one-layer anastomosis using 6-0 absorbable sutures can potentially prevent the occurrence of anastomotic stricture. Revision of most stenotic anastomosis can also be achieved using this maneuver. |
