Comparison of Modified Pleural Flap Technique vs. Standard Anastomosis for Congenital Tracheo- Esophageal Fistula Repair: A Randomized Control Trial
Article Sidebar
Main Article Content
Abstract
Background: Tracheoesophageal fistula (TEF) with or without esophageal atresia (EA) is a challenging congenital condition necessitating surgical intervention. The advent of various surgical techniques has sought to improve outcomes and reduce postoperative complications such as anastomotic leakage and stricture formation, which significantly impact neonatal morbidity and mortality.
Objective: The aim of this randomized controlled trial was to compare the efficacy of the modified pleural flap technique against the conventional anastomosis technique in the surgical repair of TEF.
Methods: Conducted at the Children’s Hospital and Institute of Child Health in Lahore, this study involved 44 full-term neonates, diagnosed with TEF, and weighing over 2 kg. Subjects were randomized into two groups: one receiving the conventional anastomosis (Group A) and the other undergoing the modified pleural flap technique (Group B). Preoperative characteristics, intraoperative details, and postoperative outcomes were meticulously recorded. Statistical analysis was performed using SPSS version 25.0, focusing on the incidence of anastomotic leakage, stricture formation, length of hospital stay, and mortality within 30 days post-surgery.
Results: Group B patients experienced significantly lower rates of anastomotic leakage by the 5th postoperative day (9.1%) and 14th postoperative day (13.6%) compared to Group A (36.4% and 40.9%, respectively) with p-values of 0.031 and 0.042. Postoperative stricture formation was also less in Group B (9.1%) compared to Group A (36.4%), with a p-value of 0.031. The mean hospital stay was longer for Group B (27.45 days) compared to Group A (22.09 days), and the mortality rate was lower in Group B, although not statistically significant (p-value = 0.148).
Conclusion: The modified pleural flap technique in TEF repair demonstrates a significant reduction in early postoperative complications, offering a promising improvement over the conventional approach. Despite a longer hospital stay, the enhanced outcomes highlight its potential for becoming the preferred surgical intervention for TEF.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Van Lennep M, Singendonk MM, Dall’Oglio L, Gottrand F, Krishnan U, Terheggen-Lagro SW, et al. Oesophageal atresia. 2019;5(1):26.
CHENNAI TN. Respiratory morbidity in children with Esophageal atresia/Tracheo Esophageal fistulae who underwent primary repair in a Tertiary care centre in South India. 2018.
Odera A, Peer N, Balakrishna Y, Gafoor MHSJJoSR. Management and Outcomes of Esophageal Atresia With or Without Tracheo-Esophageal Fistula Over 15 Years in South Africa. 2023;291:442-51.
Walk RMJSC. Esophageal atresia and tracheoesophageal fistula: Overview and considerations for the general surgeon. 2022;102(5):759-78.
Riccipetitoni G, Destro F. Esophagus. Pediatric Surgery Digest: Springer; 2022. p. 247-75.
Petrov RV, Bakhos CT, Abbas AEJJovs. Robotic substernal esophageal bypass and reconstruction with gastric conduit—frequently overlooked minimally invasive option. 2019;5.
Sampat K, Losty PDJPSI. Diagnostic and management strategies for congenital H-type tracheoesophageal fistula: a systematic review. 2021;37:539-47.
O’Shea D, Schmoke N, Porigow C, Murray LP, Chung WK, Kattan M, et al. Recent Advances in the Genetic Pathogenesis, Diagnosis, and Management of Esophageal Atresia and Tracheoesophageal Fistula: A Review. 2023;77(6):703-12.
Khlevner J, Jodorkovsky D, Bailey DD, Middlesworth W, Sethi A, Abrams J, et al. Management of adults with esophageal atresia. 2023;21(1):15-25.
ROTHENBERG SSJH, Holcomb AsPS, E-Book AsPS. 27 Esophageal Atresia and Tracheoesophageal Fistula Malformations. 2019:437.
Babu R, Goel DJJoIAoPS. Editorial Board of JIAPS. 2023;28:1.
Mohammed S, Hamilton TEJCiP. Advances in Complex Congenital Tracheoesophageal Anomalies. 2022;49(4):927-41.
Ellerkamp V, Schweizer R, Binder G, Luithle T, Schneider P, Müller R, et al. Surgery in congenital adrenal hyperplasia in context to § 1631e.
Siddiqi S, Schraufnagel DP, Siddiqui HU, Javorski MJ, Mace A, Elnaggar AS, et al. Recent advancements in the minimally invasive management of esophageal perforation, leaks, and fistulae. 2019;16(3):197-209.
Godin A, Liberman MJAoTM. The modern approach to esophageal palliative and emergency surgery. 2021;9(10).
Bowder AN, Lal DRJAiP. Advances in the Surgical Management of esophageal Atresia. 2021;68:245-59.
Sharma D, Agarwal P, Agrawal VJTS. Surgical innovation in Lmics–the perspective from India. 2022;20(1):16-40.
Abe Y, Shinoda M, Kitago M, Yagi H, Takano K, Oshima G, et al. 26th International Congress of the European Association for Endoscopic Surgery (EAES), London, United Kingdom, 30 May–1 June 2018: Video Presentations. 2018;32:S361-S429.
Innovations IASMJ. Display Poster Abstracts. 2019;14(2_suppl):116S-87S.
Carbonell AM, Warren JA, Prabhu AS, Ballecer CD, Janczyk RJ, Herrera J, et al. Reducing length of stay using a robotic-assisted approach for retromuscular ventral hernia repair: a comparative analysis from the Americas Hernia Society Quality Collaborative. 2018;267(2):210-7.
Gerakopoulos E, Walker L, Melling D, Scott S, Scott SJJoot. Surgical management of multiple rib fractures reduces the hospital length of stay and the mortality rate in major trauma patients: a comparative study in a UK major trauma center. 2019;33(1):9-14.
Shin CH, Long DR, McLean D, Grabitz SD, Ladha K, Timm FP, et al. Effects of intraoperative fluid management on postoperative outcomes: a hospital registry study. 2018;267(6):1084-92.
Lane-Fall MB, Pascual JL, Peifer HG, Di Taranti LJ, Collard ML, Jablonski J, et al. A partially structured postoperative handoff protocol improves communication in 2 mixed surgical intensive care units: findings from the handoffs and transitions in critical care (HATRICC) prospective cohort study. 2020;271(3):484-93.
Trowbridge ER, Evans SL, Sarosiek BM, Modesitt SC, Redick DL, Tiouririne M, et al. Enhanced recovery program for minimally invasive and vaginal urogynecologic surgery. 2019;30:313-21.