University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK.
Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK.
J Pediatr Surg. 2024 Jan;59(1):6-9. doi: 10.1016/j.jpedsurg.2023.09.026. Epub 2023 Sep 27.
Recent series of newborn Oesophageal Atresia (OA) repair continue to report widespread use of chest drains, gastrostomy, routine contrast studies and parenteral nutrition (PN) despite evidence suggesting these are superfluous. We report outcomes using a minimally interventional approach to post-operative recovery.
Ethically approved (15/WA/0153), single-centre, retrospective case-note review of consecutive infants with OA 2000-2022. Infants with OA and distal trache-oesophageal fistula undergoing primary oesophageal anastomosis at initial surgery were included (including those with comorbidities such as duodenal atresia, anorectal malformation and cardiac lesions). Our practice includes routine use of a trans-anastomotic tube (TAT), no routine chest drain nor gastrostomy, early enteral and oral feeding, no routine PN and no routine contrast study. Data are median (IQR).
Of total 186 cases of OA treated during the time period, 157 met the inclusion criteria of which 2 were excluded as casenotes unavailable. TAT was used in 150 infants. A chest drain was required in 13 (8%) and two infants had a neonatal gastrostomy. Enteral feeds were started on postoperative day 2 (2-3), full enteral feeds established by day 4 (4-6) and oral feeds started on day 5 (4-8). PN was required in 15%. Median postoperative length of stay was 10 days (8-17). Progress was quicker in term infants than preterm. One infant died of cardiac disease prior to neonatal discharge. Two planned post-operative contrast studies were performed (surgeon preference) and a further 7 due to clinical suspicion of anastomotic leak. Contrast study was therefore avoided in 94%. There were 2 anastomotic leaks; both presented clinically at day 4 and day 8 after oral feeds had been started.
Our minimally interventional approach is safe. It facilitates prompt recovery with lower resource use, reduced demand on nursing staff, reduced radiation burden, and early discharge home compared to published series without adversely affecting outcomes.
Level 4.
尽管有证据表明，新生儿食管闭锁（OA）修复后的一系列研究仍广泛使用胸腔引流管、胃造口术、常规对比研究和肠外营养（PN），但最近的系列研究继续报告这些方法的使用。我们报告了一种采用微创方法进行术后恢复的结果。
经伦理批准（15/WA/0153），对 2000 年至 2022 年期间连续患有 OA 的婴儿进行单中心回顾性病历回顾。研究包括在初次手术时接受原发性食管吻合术的伴有远端气管食管瘘的 OA 婴儿（包括合并十二指肠闭锁、肛门直肠畸形和心脏病变等合并症的婴儿）。我们的实践包括常规使用经吻合管（TAT）、不常规使用胸腔引流管和胃造口术、早期肠内和口服喂养、不常规使用 PN 和不常规使用对比研究。数据为中位数（IQR）。
在研究期间共治疗了 186 例 OA 病例，其中 157 例符合纳入标准，2 例因病历不可用而被排除。150 例婴儿使用了 TAT。13 例（8%）需要使用胸腔引流管，2 例婴儿进行了新生儿胃造口术。术后第 2 天（2-3 天）开始肠内喂养，第 4 天（4-6 天）完全建立肠内喂养，第 5 天（4-8 天）开始口服喂养。15%的婴儿需要使用 PN。术后中位住院时间为 10 天（8-17 天）。早产儿的恢复速度快于足月儿。1 例婴儿因心脏病在新生儿出院前死亡。由于怀疑吻合口漏，计划进行 2 次术后对比研究，另有 7 次因临床怀疑吻合口漏。因此，94%的婴儿避免了对比研究。有 2 例吻合口漏，均在口服喂养开始后第 4 天和第 8 天出现临床症状。
我们的微创方法是安全的。与已发表的系列研究相比，它促进了更快的恢复，减少了资源的使用，降低了对护理人员的需求，减少了辐射负担，并更早地出院回家，而不会对结果产生不利影响。
4 级。
