Van der Zee et al reported factors associated with anastomotic leakage after thoracoscopic repair of proximal esophageal atresia with distal fistula. These can help to identify a patient who may benefit from closer monitoring. The authors are from University Medical Center Utrecht.
Patient selection: proximal esophageal atresia with distal fistula (this appears to correspond to Spitz and Waterston Type A, which is the most common type)
Outcome: postoperative leakage at the anastomotic site
Predictors of anastomotic leakage following thoracoscopic repair:
(1) length of the proximal esophagus < 7 mm (using the distance from the topside of the first thoracic vertebra to lowest point of distal esophagus)
(2) distance from carina to proximal esophagus > 13.5 mm (referencing the lowest point of the proximal esophagus)
Since the distance are small, accurate designation of landmarks is essential.
In addition, the authors concluded that recurrent esophageal stenosis was related to gastro-esophageal reflux.
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