The diagnosis and treatment of postoperative leakage of esophageal anastomosis in patients with esophageal atresia of type III

Objective To analyze the causes of the postoperative leakage of esophageal anastomosis in patients with esophageal atresia(EA)of type Ⅲ,and to investigate the diagnosis,treatment and prognosis of the leakage.Methods Between 2000 and 2007,53 patients with esophageal atresia of type Ⅲ who underwent esophageal anastomosis in this institution were retrospectively analyzed.The incidence of leakage,the potential causes,the diagnosis and treatment of this complication were recorded and analyzed.Results In all the 53 patients,38 were males(71.7%)and 15 were females (28.3%),with the mean birth weight of 2.53±0.63 kg.Among them,21(39.62%)suffered leak-age.According to Gross classification,14 cases were type Ⅲ a and 7 were type Ⅲ b,which had significant difference(P＜0.05).In 15 patients suffering severe leakage,10 cases were type Ⅲa and 5 were Ⅲb;while in 6 patients suffering minor leakage,4 cases were typeⅢa and 2 wereⅢb.Among 21 patients with leakage,the birth weight of 9 cases(9/32)were beyond 2500 g,10 cases(10/17)were between 2 000 g and 2 500 g,and 5 cases(5/32)were less than 2 000 g.In the 21 patients with leak-age,15 cases were without any associated abnormities,5 cases were with moderate associated abnormities,and only 1 case was with severe associated abnormities.Five patients died during hospitalization,but only one died of leakage.All the other patients with leakage accepted non-operative therapy and recovered well.The anastomosis stricture index of the patients with leakage was 0.604±0.023,which was significantly higher than that in patients without leakage(0.519±0.028).Eleven patients (11/53)accepted esophageal dilatation for anastomosis stricture,in whom 6 cases had leakage while the other 5 without,which showed no statistical difference.Conclusions The incidence of esophageal anastomosis leakage is related to the distance between two ends of the esophagus.All leakage except for complete anastomotic disruption could be managed by non-surgical therapy,such as thorax drainage and parenteral nutrition,until spontaneous closures formed in the next 1 to 3 weeks. Key words: Esophageal atresia; Stomas