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Glycopyrrolate as an Adjunct in the Management of Anastomotic Leak Following Repair of Esophageal Atresia: A Clinicoradiological Perspective.

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Title: Glycopyrrolate as an Adjunct in the Management of Anastomotic Leak Following Repair of Esophageal Atresia: A Clinicoradiological Perspective.
Authors: Gupta, Rahul1 meetsurgeon007@gmail.com, Chopra, Ashok K.1, Dogra, Neelam2
Source: Journal of Indian Association of Pediatric Surgeons. Mar/Apr2024, Vol. 29 Issue 2, p143-151. 9p.
Subject Terms: *COMBINATION drug therapy, *SURGICAL anastomosis, *QUESTIONNAIRES, *TREATMENT effectiveness, *RETROSPECTIVE studies, *TERTIARY care, *GLYCOPYRROLATE, *SURGICAL complications, *DRUG efficacy, ESOPHAGEAL atresia
Abstract: Context: Anastomotic leak after primary repair of esophageal atresia (EA) with tracheoesophageal fistula (TEF) is a well-known complication and can represent a challenging clinical scenario. Aims: The present study aimed to evaluate the role of glycopyrrolate as an adjunct in the treatment of anastomotic leak after primary repair of EA Vogt type 3b. Settings and Design: A retrospective study was carried out in our tertiary care teaching institute from January 2015 to December 2022. Materials and Methods: Neonates with EA with distal TEF with primary repair who had developed anastomotic leak, managed by the author(s), were studied. The study included patients with major, minor, and radiological leaks. Glycopyrrolate was administered in the dose of 4 µg/kg 8 hourly. The outcomes of the study were either resolution or progression of the leak. Results: There were 21 patients who were managed with glycopyrrolate in addition to the classical treatment of the anastomotic leak following repair of EA with distal TEF. The male: female ratio was 1:1.1. All the cases had anastomotic leaks with either clinically detectable in the chest tube (15) or radiological leak (6). The leaks were detected early in patients with major leak (mean = 3.2 ± 0.84 days) compared to minor leak (mean =4.9 ± 1.29 days). Radiological leaks were detected in all the neonates on postoperative day 7. In five patients with major leak, there was a negligible reduction in the amount of chest tube output, and were subjected to diversion procedures. There were a total of three deaths out of five in this group. In 10 patients with minor leak, there was complete resolution of anastomotic leak in eight patients (80%); there was one patient each with mortality and diversion procedure. The patients with a radiological leak (6) did not show any deterioration, and they were fed 1--5 days after the esophagogram. Conclusions: Glycopyrrolate may be an advantageous postoperative adjunct in the management of minor and radiological leak after tracheoesophageal repair. [ABSTRACT FROM AUTHOR]
Copyright of Journal of Indian Association of Pediatric Surgeons is the property of Wolters Kluwer India Pvt Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Glycopyrrolate as an Adjunct in the Management of Anastomotic Leak Following Repair of Esophageal Atresia: A Clinicoradiological Perspective.
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Gupta%2C+Rahul%22">Gupta, Rahul</searchLink><relatesTo>1</relatesTo><i> meetsurgeon007@gmail.com</i><br /><searchLink fieldCode="AR" term="%22Chopra%2C+Ashok+K%2E%22">Chopra, Ashok K.</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Dogra%2C+Neelam%22">Dogra, Neelam</searchLink><relatesTo>2</relatesTo>
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  Label: Source
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  Data: <searchLink fieldCode="JN" term="%22Journal+of+Indian+Association+of+Pediatric+Surgeons%22">Journal of Indian Association of Pediatric Surgeons</searchLink>. Mar/Apr2024, Vol. 29 Issue 2, p143-151. 9p.
– Name: Subject
  Label: Subject Terms
  Group: Su
  Data: *<searchLink fieldCode="DE" term="%22COMBINATION+drug+therapy%22">COMBINATION drug therapy</searchLink><br />*<searchLink fieldCode="DE" term="%22SURGICAL+anastomosis%22">SURGICAL anastomosis</searchLink><br />*<searchLink fieldCode="DE" term="%22QUESTIONNAIRES%22">QUESTIONNAIRES</searchLink><br />*<searchLink fieldCode="DE" term="%22TREATMENT+effectiveness%22">TREATMENT effectiveness</searchLink><br />*<searchLink fieldCode="DE" term="%22RETROSPECTIVE+studies%22">RETROSPECTIVE studies</searchLink><br />*<searchLink fieldCode="DE" term="%22TERTIARY+care%22">TERTIARY care</searchLink><br />*<searchLink fieldCode="DE" term="%22GLYCOPYRROLATE%22">GLYCOPYRROLATE</searchLink><br />*<searchLink fieldCode="DE" term="%22SURGICAL+complications%22">SURGICAL complications</searchLink><br />*<searchLink fieldCode="DE" term="%22DRUG+efficacy%22">DRUG efficacy</searchLink><br /><searchLink fieldCode="DE" term="%22ESOPHAGEAL+atresia%22">ESOPHAGEAL atresia</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Context: Anastomotic leak after primary repair of esophageal atresia (EA) with tracheoesophageal fistula (TEF) is a well-known complication and can represent a challenging clinical scenario. Aims: The present study aimed to evaluate the role of glycopyrrolate as an adjunct in the treatment of anastomotic leak after primary repair of EA Vogt type 3b. Settings and Design: A retrospective study was carried out in our tertiary care teaching institute from January 2015 to December 2022. Materials and Methods: Neonates with EA with distal TEF with primary repair who had developed anastomotic leak, managed by the author(s), were studied. The study included patients with major, minor, and radiological leaks. Glycopyrrolate was administered in the dose of 4 µg/kg 8 hourly. The outcomes of the study were either resolution or progression of the leak. Results: There were 21 patients who were managed with glycopyrrolate in addition to the classical treatment of the anastomotic leak following repair of EA with distal TEF. The male: female ratio was 1:1.1. All the cases had anastomotic leaks with either clinically detectable in the chest tube (15) or radiological leak (6). The leaks were detected early in patients with major leak (mean = 3.2 ± 0.84 days) compared to minor leak (mean =4.9 ± 1.29 days). Radiological leaks were detected in all the neonates on postoperative day 7. In five patients with major leak, there was a negligible reduction in the amount of chest tube output, and were subjected to diversion procedures. There were a total of three deaths out of five in this group. In 10 patients with minor leak, there was complete resolution of anastomotic leak in eight patients (80%); there was one patient each with mortality and diversion procedure. The patients with a radiological leak (6) did not show any deterioration, and they were fed 1--5 days after the esophagogram. Conclusions: Glycopyrrolate may be an advantageous postoperative adjunct in the management of minor and radiological leak after tracheoesophageal repair. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Journal of Indian Association of Pediatric Surgeons is the property of Wolters Kluwer India Pvt Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.4103/jiaps.jiaps_207_23
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 9
        StartPage: 143
    Subjects:
      – SubjectFull: COMBINATION drug therapy
        Type: general
      – SubjectFull: SURGICAL anastomosis
        Type: general
      – SubjectFull: QUESTIONNAIRES
        Type: general
      – SubjectFull: TREATMENT effectiveness
        Type: general
      – SubjectFull: RETROSPECTIVE studies
        Type: general
      – SubjectFull: TERTIARY care
        Type: general
      – SubjectFull: GLYCOPYRROLATE
        Type: general
      – SubjectFull: SURGICAL complications
        Type: general
      – SubjectFull: DRUG efficacy
        Type: general
      – SubjectFull: ESOPHAGEAL atresia
        Type: general
    Titles:
      – TitleFull: Glycopyrrolate as an Adjunct in the Management of Anastomotic Leak Following Repair of Esophageal Atresia: A Clinicoradiological Perspective.
        Type: main
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            NameFull: Gupta, Rahul
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            NameFull: Chopra, Ashok K.
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            NameFull: Dogra, Neelam
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            – D: 01
              M: 03
              Text: Mar/Apr2024
              Type: published
              Y: 2024
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              Value: 09719261
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              Value: 29
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              Value: 2
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            – TitleFull: Journal of Indian Association of Pediatric Surgeons
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