PROTECTION OF THE ESOPHAGEAL ANASTOMOSIS BY THE USE OF ELECTIVE : POSTOPERATIVE-VENTILATION AFTER REPAIR OF GROSS TYPE C ESOPHAGEAL ATRESIA
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In neonates with esophageal atresia and distal tracheoesophageal fistula (EA/TEF) it should be possible to undertake repair without esophageal anastomotic complications. The aim of this study was to evaluate the role of planned ventilation after surgery. In 72 consecutive cases of EA/TEF the defect was repaired and followed by non-reversal of anesthesia and graded withdrawal of ventilatory support in the post-operative period. If the anastomosis was considered to be under undue tension, muscle relaxant was used 48 to 72 hours. Clinical information was obtained retrospectively by a chart review. No leaking anastomosis was identified, and no recurrent TEF developed. The survival rate of infants undergoing definitive surgical repair of EA-TEF was 95.8%. Fifty-one of them (71%) were extubated within five days after surgery. Eleven neonates with associated prematurity and/or cardiac diseases needed re-intubation but, in all but one, weaning from the respirator was achieved. Routine planned respiratory care immediately after repair of EA-TEF protects the esophageal anastomosis, and by reducing anastomotic complications, results in an improved outcome of treatment.
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