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01.05.2009 | Ausgabe 5/2009

World Journal of Surgery 5/2009

Role of Fibrin Glue in the Prevention of Cervical Leakage and Strictures After Esophageal Reconstruction of Caustic Injury

Zeitschrift:
World Journal of Surgery > Ausgabe 5/2009
Autoren:
Julián Alberto Saldaña-Cortés, Francisco Larios-Arceo, Emilio Prieto-Díaz-Chávez, Eliseo Portilla De Buen, Salvador González-Mercado, Andrea Socorro Alvarez-Villaseñor, Manuel Rodrigo Prieto-Aldape, Clotilde Fuentes-Orozco, Alejandro González-Ojeda
Wichtige Hinweise
This study was supported in part by a grant from the National Council of Science and Technology of Mexico (CONACYT-SiMorelos 2000-0302003).

Abstract

Background

The colon is the organ most commonly used for esophageal reconstruction after severe caustic injury. Complications of cervical anastomosis are very common. Fibrin sealant may reduce the incidence of complications in this high-risk anastomosis. The purpose of the present study was to assess the role of fibrin glue in the prevention of leakage and stricture at cervical coloesophageal anastomoses in children treated with esophageal reconstruction after caustic injury.

Methods

This was a case–control study of children with caustic esophageal injury treated surgically with esophageal reconstruction over a 10-year period. In the study group 3–4 ml of fibrin glue was placed over the anastomosis. The following variables were assessed: age, sex, weight, leakage or stricture at the cervical anastomosis, morbidity, and mortality.

Results

The study group included 14 children, and the control group included 24 children. There were no differences in the distributions of sex, age, anthropometric variables, or preoperative laboratory test results. All children underwent esophageal replacement with colon substitution through the retrosternal space. Dehiscence and leakage at the cervical anastomosis were observed in 50% of children in the control group and 28.5% of children in the study group (P = 0.17). Strictures were observed in 7.15% of the study group and 20.8% of the control group, and 5 and 17 children, respectively, developed cervical complications (P = 0.03). There were no differences in major complications, and mortality was similar in the two groups (P = 0.60).

Conclusions

Fibrin glue, when used as a sealant for cervical coloesophageal anastomosis, can reduce the risk of leakage and stricture.

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