Revisiting the role of routine retropleural drainage after repair of esophageal atresia with distal tracheoesophageal fistula.

PURPOSE: The aim of this study was to review routine retropleural drainage in esophageal atresia with distal tracheoesophageal fistula (TEF).

METHODS: The charts of 52 patients diagnosed with TEF between 1987 and 1997 were reviewed. Data collected included gestational age, birth weight, associated congenital anomalies, respiratory status, operative technique and timing, size of gap, tension on the anastomosis, complications related to the drain, and esophageal anastomotic leak (incidence, diagnosis, and treatment).

RESULTS: A total of 52 cases of TEF were identified. Data on sex, gestation age, birth weights, and malformations are summarized. Forty-seven patients underwent a single-stage extrapleural repair. Only one leak was identified in the single-stage group on routine day 7 esophagogram: a Waterson C patient who was clinically well with minimal drainage. The only other leak was in a class C patient who had undergone a staged repair because of an initial long gap. None of the favorable Waterston class patients suffered a leak.

CONCLUSIONS: A routine retropleural drain placed near the anastomosis may not be necessary in all cases of TEF. Good prognosis patients (Waterston class A and B) who undergo an uncomplicated extrapleural repair without undue tension do not appear to benefit from having a chest drain in place, and there is potential for complications. In complicated cases, however, retropleural drainage remains a reasonable adjunct.