Application of Enhanced Recovery After Surgery for Congenital Esophageal Atresia During Perioperative Period

Study Overview
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Brief Summary
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The purpose of this prospective cohort study is to evaluate the safety and effectiveness of enhanced recovery after surgery (ERAS) to perform routine thoracoscopic repair for elective esophageal atresia type C

Detailed Description
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The concept of enhanced recovery after surgery was introduced by Kelhet et al. in the 1990s for colorectal surgery, and it referred to a group of measures performed during a patient's treatment course to improve operative outcomes, reduce complications, and speed up patient recovery. It is now widely applied in many surgical fields, such as thoracic surgery The esophageal atresia is a group of birth defects including a break in continuity of the esophagus with or without persistent communication with the trachea (tracheoesophageal fistula), and occurs in approximately 1 in 3500-4500 births. Refinements in surgical technique and perioperative care have dramatically decreased mortality rates of infants with EA/TEF, such that mortality is generally related to associated anomalies. Accordingly, the current focus in optimizing patient outcomes has shifted toward decreasing morbidity, including minimizing postoperative complications, speeding up recovery. One of the milestones in recent years is the introduction and rapid development of video-assisted thoracoscopic surgery (VATS). This surgical method has beneficial effects on patient's post-operative recovery and functional status without compromising surgical resection. A range of operations can now be safely performed via VATS. Although the survival rate of EA is more than 90 percent, there are still many postoperative complications, including anastomotic leakage, recurrence of esophagotracheal fistula, esophageal stenosis, gastroesophageal reflux and other problems, which seriously affect the prognosis. For decades, in order to reduce the complications, post-operative muscle paralysis, mechanical ventilation and urinary catheterization were performed for at least 2 days as convention perioperative management. However, complications after general anesthesia and endotracheal intubation are not negligible, and urinary catheterization is associated with urethral trauma, discomfort, infection. The main reason for placement of chest tube is for post-operative monitoring. However, a chest drain is a recognized cause of post-operative pain and can affect patient's post-operative morbility as well as effective chest physiotherapy. The current project aims to explored the possibility of ERAS approach (i.e. weaning mechanical ventilation after surgery (less than 48h), no post-operative chest tube and urinary catheterization) for specific Type C EA (the distance of blind end is less than 2.5cm, weight>2.4Kg, without related malformations (heart, kidney, for example), and without structural heart disease (excluding patent ductus arteriosus, patent foramen ovale, or atrial septal defect)).

Official Title
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Application of Enhanced Recovery After Surgery for Congenital Esophageal Atresia During Perioperative Period

Conditions
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Esophageal Atresia, Enhanced Recovery After Surgery

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: congenital esophageal atresia with type C the distance of blind end is less than 2.5cm weight>2.4Kg without related malformations (heart, kidney), without structural heart disease (excluding patent ductus arteriosus, patent foramen ovale, or atrial septal defect) Exclusion Criteria: Type A/B/D/E esophageal atresia the distance of blind end is more than 2.5cm weight is less than 2.4Kg with Inherited chromosomal related diseases with congenital heart disease (excluding patent ductus arteriosus, patent foramen ovale, or atrial septal defect) preoperative severe pneumonia need mechanical ventilation

Ages Eligible for Study
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Minimum Age: 1 Hour
Maximum Age: 1 Month

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| enhanced recovery after surgery group<br>weaning mechanical ventilation after surgery (less than 48h), no post-operative chest tube and urinary catheterization) Establishment of early feeding (D3 post-operative) | |
| control group<br>the time of mechanical ventilation after surgery is more than 48 hours routine postoperative indwelling chest tube and urinary catheterization) Establishment of feeding after D3 post-operative | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants with post-operative anastomotic leak | Comparison of the morbidity of anastomotic leak between ERAS group and control group, including major and minor leaks | one month after surgery | 
| Number of participants with post-operative recurrent fistula | Comparison of the morbidity of recurrent fistula between ERAS group and control group | two years after surgery | 
| Number of participants with post-operative anastomotic strictures | Comparison of the morbidity of anastomotic strictures between ERAS group and control. Anastomotic strictures defined as there are symptoms which require intervention. | two years after surgery | 
| Total number of participants with post-operative complications | Vocal cord dysfunction, Surgical site infection, Chylothorax, Gastroesophageal reflux, pleural effusion and other complications | two years after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| length of stay | length of hospital stay | up to 24 weeks | 
| Length of nutritional support in hospital | Length of nutritional support in hospital | up to 24 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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esophageal atresia, enhanced recovery after surgery, perioperative management