Browsing by Author "Erdem, Ali Onur"

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Outcome of very low and low birth weight infants with esophageal atresia: Results of the Turkish esophageal atresia registry
(Georg Thieme Verlag, 2021-06-01) Öztan, Mustafa O.; Soyer, Tutku; Öztorun, Can, I; Fırıncı, Binali; Durakbaşa, Çiğdem U.; Dökümcü, Zafer; Göllü, Gülnur; Akkoyun, İbrahim; Demirel, Dilek; Karaman, Ayşe; Çiftci, İlhan; İlhan, Hüseyin; Parlak, Ayşe; Özden, Önder; Cömert, Hatice S. Y.; Oral, Akgün; Tekant, Gonca; Kıyan, Gürsu; Erginel, Başak; Güvenç, Ünal; Erdem, Ali Onur; Ertürk, Nazile; Yıldız, Abdullah; PARLAK, AYŞE; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Cerrahisi Anabilim Dalı.; AAH-6766-2021
Introduction The data of the Turkish Esophageal Atresia Registry (TEAR) was evaluated to define the outcome of very low birth weight (VLBW) and low BW (LWB) infants with esophageal atresia (EA).Materials and Methods The data registered by 24 centers between 2014 and 2018 were evaluated for demographic features, prenatal findings, associated anomalies, surgical treatment, and outcome. Patients were enrolled in three groups according to their BWs (VLBW <1,500g), LWB=1,500-2,500g), and normal BW (NBW; >2,500g).Results Among the 389 cases, there were 37 patients (9.5%) in the VLBW group, 165 patients (42.4%) in the LBW group, and 187 patients (48.1%) in the NBW group. Prenatal diagnosis rates were similar among the three groups (29.7, 34.5, and 24.6%, respectively). The standard primary anastomosis was achieved at a significantly higher rate in NWB cases than in the other groups ( p <0.05). In patients with tracheoesophageal fistula (TEF), patients of the NBW group had significantly higher rates of full oral feedings, when compared with VLBW and LBW cases ( p <0.05). At the end of the first year, when we evaluate all patients, the number of cases with fistula recanalization and esophageal anastomotic strictures (AS) requiring esophageal dilatation was similar among the groups. The weight and height measurements at 6 months and 1 year of age of the survivors were similar in all the groups. The overall mortality rate was significantly higher in the VLBW and LBW groups, when compared with the NBW patients, even in patients with tension-free anastomosis ( p <0.05). The incidence of the associated anomalies was 90.6% in cases with mortality, which was significantly higher than in survivors (59.6%; p <0.05). According to Spitz's classification, the survival rate was 87.1% in class I, 55.3% in class II, and 16.7% in class III. The most common causes of mortality were associated with cardiovascular diseases, pneumonia, and sepsis.Conclusion The national data of TEAR demonstrates that the developmental and feeding parameters are better in NBW patients. Although VLBW patients have higher risk of developing fistula canalization than the LBW and NBW groups, long-term complications, such as anastomotic strictures, weight, and height values, after 1 year are similar in both groups. According to our results, associated anomalies and LBWs are still significant risk factors for mortality in cases with EA.
The effect of azygos vein preservation on postoperative complications after esophageal atresia repair: Results from the turkish esophageal atresia registry
(W B Saunders Co-elsevier Inc, 2021-10-24) Soyer, Tutku; Oztorun, Can Ihsan; Firinci, Binali; Durakbasa, Cigdem Ulukaya; Bahadir, Gulnur Gollu; Karaman, Ayse; Dokumcu, Zafer; Akkoyun, Ibrahim; Demirel, Berat Dilek; Oztan, Mustafa Onur; Ciftci, Ilhan; Ilhan, Huseyin; Yalcin, Sonay; Ozden, Onder; Tekant, Gonca Topuzlu; Kiyan, Gursu; Oral, Akgun; Guvenc, Unal; Erginel, Basak; Yildiz, Abdullah; Erdem, Ali Onur; Uzunlu, Osman; Erturk, Nazile; Aydin, Emrah; Samsum, Hakan; Arslan, Umut Ece; Parlak, Ayse; PARLAK, AYŞE; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; 0000-0001-7686-2561; AAH-6766-2021
Aim: Preservation of the azygos vein (AV) maintains normal venous drainage of the mediastinum and decreases postoperative congestion. The modification of esophageal atresia (EA) repair by preserving AV may prevent postoperative complications and may lead to better outcomes. The data from the Turkish Esophageal Atresia Registry (TEAR) were evaluated to define the effect of AV preservation on postoperative complications of patients with EA. Methods: Data from TEAR for a period of five years were evaluated. Patients were enrolled into two groups according to the preservation of AV. Patients with divided (DAV) and preserved AV (PAV) were evaluated for demographic and operative features and postoperative complications for the first year of life. The DAV and PAV groups were compared according to the postoperative complications, such as fis-tula recanalization, symptomatic strictures, anastomotic leaks, total number of esophageal dilatations, and anti-reflux surgery. In addition, respiratory problems, which required treatment, were compared between groups. Results: Among 502 registered patients; the data from 315 patients with the information of AV ligation were included. The male female ratio of DAV (n = 271) and PAV (n = 44) groups were 150:121 and 21:23, respectively (p > 0.05). The mean body weight, height, gestational age, and associated anomalies were similar in both groups (p > 0.05). The esophageal repair with thoracotomy was significantly higher in DAV group, when compared to the PAV group (p < 0.05). The rates of primary anastomosis and ten-sioned anastomosis were similar in both groups (p > 0.05). There was no difference between DAV and PAV groups for anastomotic leaks, symptomatic anastomotic strictures, fistula recanalization, and the re-quirement for anti-reflux surgery (p > 0.05). The rate of respiratory problems, which required treatment, was significantly higher in the DAV group (p < 0.05) Conclusion: The data in the TEAR demonstrated that preserving the AV during EA repair led to no sig-nificant advantage on postoperative complications, with exception of respiratory problems. AV should be preserved as much as possible to maintain a normal mediastinal anatomy and to avoid respiratory com-plications. (c) 2020 Elsevier Inc. All rights reserved.
The effect of postoperative ventilation strategies on postoperative complications and outcomes in patients with esophageal atresia: Results from the Turkish Esophageal Atresia Registry
(Wiley, 2022-11-25) Comert, Hatice Sonay Yalcin; Guney, Dogus; Durakbasa, Cigdem Ulukaya; Dokumcu, Zafer; Soyer, Tutku; Firinci, Binali; Ciftci, Ilhan; Oztan, Mustafa Onur; Demirel, Berat Dilek; Parlak, Ayşe; Gollu, Gulnur; Karaman, Ayse; Akkoyun, Ibrahim; Gul, Cengiz; Ilhan, Huseyin; Oral, Akgun; Ozcan, Rahsan; Ozen, Onder; Kiyan, Gursu; Erdem, Ali Onur; Ozaydin, Seyithan; Uzunlu, Osman; Yildiz, Abdullah; Erginel, Basak; Erturk, Nazile; Bilici, Salim; Samsum, Hakan; Ozen, Mehmet Ali; Ozcakir, Esra; Aydin, Emrah; Mert, Mehmet; Topbas, Murat; PARLAK, AYŞE; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Cerrahisi Anabilim Dalı.; AAH-6766-2021
ObjectivesPostoperative ventilatory strategies in patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) may have an impact on early postoperative complications. Our national Esophageal Atresia Registry was evaluated to define a possible relationship between the type and duration of respiratory support on postoperative complications and outcome. Study DesignAmong the data registered by 31 centers between 2015 and 2021, patients with esophago-esophageal anastomosis (EEA)/tracheoesophageal fistula (TEF) were divided into two groups; invasive ventilatory support (IV) and noninvasive ventilatory support and/or oxygen support (NIV-OS). The demographic findings, gestational age, type of atresia, associated anomalies, and genetic malformations were evaluated. We compared the type of repair, gap length, chest tube insertion, follow-up times, tensioned anastomosis, postoperative complications, esophageal dilatations, respiratory problems requiring treatment after the operation, and mortality rates. ResultsAmong 650 registered patients, 502 patients with EEA/TEF repair included the study. Four hundred and seventy of patients require IV and 32 of them had NIV-OS treatment. The IV group had lower mean birth weights and higher incidence of respiratory problems when compared to NIV-OS group. Also, NIV-OS group had significantly higher incidence of associated anomalies than IV groups. The rates of postoperative complications and mortality were not different between the IV and NIV-OS groups. ConclusionWe demonstrated that patients who required invasive ventilation had a higher incidence of low birth weight and respiratory morbidity. We found no relation between mode of postoperative ventilation and surgical complications. Randomized controlled trials and clinical guidelines are needed to define the best type of ventilation strategy in children with EA/TEF.