e-Article
The Importance of Upper Pouch Contrast X-ray Radiography in Esophageal Atresia: A Retrospective Analysis/Ozofagus Atrezisinde Ust Kese Kontrastli X-isini Radyografisinin Onemi: Retrospektif Analiz
Original Article
Original Article
Document Type
Academic Journal
Source
Journal of Dr. Behcet Uz Children’s Hospital. August 2022, Vol. 12 Issue 2, p136, 6 p.
Subject
Language
English
ISSN
2146-2372
Abstract
INTRODUCTION Tracheoesophageal fistula (TEF) and esophageal atresia (EA) are congenital anomalies characterized by an abnormal communication between the trachea and the proximal and/or distal esophagus segments. The incidence of EA [...]
Objective: To investigate the effectiveness of preoperative upper pouch radiography in determining the treatment method in neonates with esophageal atresia (EA) and also to analyze the contribution of radiographic assessment of upper esophageal level to the prediction of anastomotic tension. Method: Neonates who underwent primary esophagus repair due to EA with distal fistula between 2014 and 2020 were analyzed retrospectively. Upper esophageal levels assessed on preoperative upper pouch radiographs and during surgery were compared. Results: A total of 36 cases were included in the study. Contrast-enhanced upper pouch radiograms were obtained using a thin catheter in 18 (50%) patients and using a thick catheter in 18 (50%) patients. The upper esophageal levels of preoperative pouch radiographs and surgery were consistent in 80.5% (n=29) and not consistent in 19.5%. The rate of compliance between radiographic and intraoperative levels was found to be significantly higher in the use of thick catheters compared to thin catheters (p=0.03). Six patients (16.6%) whose upper pouch level was in the 1st or 2nd thoracic vertebra had tense anastomosis. Conclusion: Withdrawing the upper pouch radiography by advancing a thick catheter is effective for determining the actual level of the upper esophagus. If the upper esophageal pouch is at the 1st or 2nd thoracic level on the radiographs obtained with a thick catheter, it can be predicted that the anastomosis will be tense. Keywords: Esophageal atresia, diagnosis, newborn, surgery, upper pouch graphy Amac: Ozefagus atrezili (OA) yenidoganlarda preoperatif ust pos radyografisinin tedavi yonteminin belirlenmesindeki etkinligini arastirmak ve ayrica ust ozefagus seviyesinin radyografik degerlendirmesinin anastomoz gerilimi tahminine katkisini analiz etmektir. Yontem: 2014-2020 yillari arasinda distal fistullu OA nedeniyle primer ozefagus onarimi yapilan yenidoganlar retrospektif olarak incelendi. Preoperatif ust pos grafilerinde ve ameliyat sirasinda degerlendirilen ust ozefagus seviyeleri karsilastirildi. Bulgular: Calismaya toplam 36 olgu dahil edildi. On sekiz (%50) hastada ince kateter, 18 (%50) hastada kalin kateter kullanilarak kontrastli ust pos grafileri cekildi. Preoperatif pos radyografileri ve intraoperatif ust ozefagus seviyeleri %80,5'te (n=29) tutarliydi; %19,5'te tutarli degildi. Kalin kateter kullaniminda radyografik ve intraoperatif duzeyler arasindaki uyum orani ince kateterlere gore anlamli olarak yuksek bulundu (p=0,03). Ust pos seviyesi 1. veya 2. torasik vertebrada olan alti hastada (%16.6) anastomoz gergin olarak yapilabildi. Sonuc: Kalin kateter ilerletilerek ust pos radyografisinin cekilmesi, ust ozefagusun gercek seviyesinin belirlenmesinde etkilidir. Kalin kateter ile cekilen grafilerde ust ozefagus posu 1. veya 2. torasik seviyede ise anastomozun gergin olacagi tahmin edilebilir. Anahtar kelimeler: Ozefagus atrezisi, tani, yenidogan, cerrahi, ust pos grafisi
Objective: To investigate the effectiveness of preoperative upper pouch radiography in determining the treatment method in neonates with esophageal atresia (EA) and also to analyze the contribution of radiographic assessment of upper esophageal level to the prediction of anastomotic tension. Method: Neonates who underwent primary esophagus repair due to EA with distal fistula between 2014 and 2020 were analyzed retrospectively. Upper esophageal levels assessed on preoperative upper pouch radiographs and during surgery were compared. Results: A total of 36 cases were included in the study. Contrast-enhanced upper pouch radiograms were obtained using a thin catheter in 18 (50%) patients and using a thick catheter in 18 (50%) patients. The upper esophageal levels of preoperative pouch radiographs and surgery were consistent in 80.5% (n=29) and not consistent in 19.5%. The rate of compliance between radiographic and intraoperative levels was found to be significantly higher in the use of thick catheters compared to thin catheters (p=0.03). Six patients (16.6%) whose upper pouch level was in the 1st or 2nd thoracic vertebra had tense anastomosis. Conclusion: Withdrawing the upper pouch radiography by advancing a thick catheter is effective for determining the actual level of the upper esophagus. If the upper esophageal pouch is at the 1st or 2nd thoracic level on the radiographs obtained with a thick catheter, it can be predicted that the anastomosis will be tense. Keywords: Esophageal atresia, diagnosis, newborn, surgery, upper pouch graphy Amac: Ozefagus atrezili (OA) yenidoganlarda preoperatif ust pos radyografisinin tedavi yonteminin belirlenmesindeki etkinligini arastirmak ve ayrica ust ozefagus seviyesinin radyografik degerlendirmesinin anastomoz gerilimi tahminine katkisini analiz etmektir. Yontem: 2014-2020 yillari arasinda distal fistullu OA nedeniyle primer ozefagus onarimi yapilan yenidoganlar retrospektif olarak incelendi. Preoperatif ust pos grafilerinde ve ameliyat sirasinda degerlendirilen ust ozefagus seviyeleri karsilastirildi. Bulgular: Calismaya toplam 36 olgu dahil edildi. On sekiz (%50) hastada ince kateter, 18 (%50) hastada kalin kateter kullanilarak kontrastli ust pos grafileri cekildi. Preoperatif pos radyografileri ve intraoperatif ust ozefagus seviyeleri %80,5'te (n=29) tutarliydi; %19,5'te tutarli degildi. Kalin kateter kullaniminda radyografik ve intraoperatif duzeyler arasindaki uyum orani ince kateterlere gore anlamli olarak yuksek bulundu (p=0,03). Ust pos seviyesi 1. veya 2. torasik vertebrada olan alti hastada (%16.6) anastomoz gergin olarak yapilabildi. Sonuc: Kalin kateter ilerletilerek ust pos radyografisinin cekilmesi, ust ozefagusun gercek seviyesinin belirlenmesinde etkilidir. Kalin kateter ile cekilen grafilerde ust ozefagus posu 1. veya 2. torasik seviyede ise anastomozun gergin olacagi tahmin edilebilir. Anahtar kelimeler: Ozefagus atrezisi, tani, yenidogan, cerrahi, ust pos grafisi