Does postoperative ventilation have an effect on the integrity of the anastomosis in repaired oesophageal atresia?

Several authors have claimed that the use of postoperative ventilation or g raded withdrawal of respiratory support reduces the incidence of anastomoti c complications after repair of oesophageal atresia, particularly where the gap between the oesophageal ends has been extensive or where the anastomos is has been constructed under tension. Careful review of their data reveals little objective evidence to either support or refute this contention. Man y institutions are achieving low leakage rates following oesophageal anasto mosis in oesophageal atresia, but to date there has been no controlled stud y to show that the use of neck flexion, muscle paralysis, intubation and as sisted ventilation postoperatively influences the integrity of the anastomo sis. The sequence of observations that led to the presumed relationship bet ween postoperative ventilation and oesophageal leak is reviewed. It would a ppear that the effect of postoperative ventilation and paralysis on the oes ophageal anastomosis is yet to be determined.