THE VALUE OF EARLY POSTOPERATIVE OESOPHAGOGRAPHY FOLLOWING REPAIR OF ESOPHAGEAL ATRESIA

The aim of the study was to examine the relationship between anastomot ic leaks and the development of symptomatic anastomotic strictures aft er primary repair of oesophageal atresia (OA) with or without tracheo- oesophageal fistula (TOF) and the prognostic value of the anastomotic appearance on postoperative oesophagography. The records and X-ray fil ms of 49 patients with OA with or without TOF admitted between January 1990 and June 1995 were reviewed retrospectively. Of these, 37 had a primary repair (34 immediate and 3 delayed) and a postoperative contra st swallow was done between day 5 and day 30 (median day 7). Radiologi cal leaks were documented. In addition, the maximum transverse diamete rs of the upper pouch and anastomotic region and the length of the ana stomotic narrow segment were measured: the ratio of upper-pouch diamet er to that of the anastomosis was calculated (anastomotic index, AI). The need for dilatation of symptomatic anastomotic strictures and for repeat dilatation as a separate episode were documented. Of the 37 pat ients, 4 developed an anastomotic leak (11%), 3 radiological and 1 cli nical. A symptomatic stricture occurred in 55% of patients. There was no correlation between a leak and later development of a symptomatic s tricture, although the small number of patients with leaks precluded d efinite conclusions. No radiological leak. progressed to a clinical le ak. There was no correlation between the AI or the length of the anast omotic narrow segment and the need for dilatation, the need for repeat dilatation, or the number of dilatations. In this study, the presence of a leak, the AI, and the length of the narrow segment on early post operative contrast swallow did not correlate with the later developmen t of a symptomatic stricture. A radiological leak was of no clinical s ignificance. Since major leaks are apparent clinically, an early routi ne contrast study did not influence management and is not necessary.