Management of anastomotic leakage after primary esophageal atresia repair

ABSTRACT Objective: The aim of this study is to evaluate the clinical outcomes of the neonates with esophageal atresia (EA) operated with primary repair and to discuss the management of anastomotic leakage (AL) after surgical repair for esophageal atresia. Methods: Data from 82 neonates with EA who underwent primary repair were retrospectively analyzed. 18 early fatal cases due to cardiac anomaly, prematurity, sepsis, and etc were excluded from the study. The remaining 64 cases were evaluated for early and late complications. Postoperative AL occurred in 15 cases [AL (+), n = 15] and did not in the other 49 cases [AL (–), n = 49] and the results were compared between two groups. Results: In 15 out of 64 (23%) neonates, AL occurred postoperatively. All of the anastomotic leakages were successfully treated with conservative treatment (tube thorocostomy, broad–spectrum antibiotic, nasojejunal breast milk feeding in the early stages via the transanastomotic catheter inserted fluoroscopically. Comparing AL (+) and AL (–) groups for postoperative complications, the incidence of the tracheoesophageal fistula for the AL (+) group was statistically significantly higher than AL (–) group (p<0.001). On the other hand, the incidences for esophageal stricture, gastroesophageal reflux, tracheomalacia and esophageal dysmotility were observed to be similar for both groups. Conclusion: The AL occurred after primary repair of the EA could be treated with conservative treatment (broad–spectrum antibiotic treatment, tube thoracostomy and nasojejunal feeding) without the need for surgical procedure and total parenteral nutrition. KEY WORDS: Esophageal atresia, anastomotic leakage, esophageal stricture, tracheoesophageal fistula