L. O. Benedict1, S. Bairdain2, J. K. Paulus4, C. Jackson1, C. Chen2, C. Kelleher3 1Tufts Medical Center,Pediatric Surgery,Boston, MA, USA 2Children’s Hospital Boston,Pediatric Surgery,Boston, MA, USA 3Massachusetts General Hospital,Pediatric Surgery,Boston, MA, USA 4Tufts Clinical And Translational Science Institute,Boston, MA, USA
Introduction: Foregut duplication cysts are rare congenital anomalies that require surgical intervention with approximately 10-15% of all gastrointestinal duplication cysts originating from the esophagus. Consensus is lacking among surgeons regarding closure of the esophageal muscle layer following resection of an esophageal duplication cyst and long-term outcomes are poorly documented. Therefore, we sought to determine whether closure of the esophageal muscle layer following resection influences short or long-term outcomes.
Methods: A retrospective cohort study performed at three institutions affiliated with childrens hospitals was performed. Patients undergoing resection of esophageal duplication cysts between 1990-2012 were classified according to whether the esophageal muscle layer was closed or left open. Demographic data, surgical technique, pre-operative symptoms and both short-term (< 30 days) and long-term (≥ 30 days) complication rates were abstracted from patient medical records.
Results: Twenty-five patients were identified with a median age of 15 years old (range: 2 months to 68 years old). Eleven patients had the esophageal muscle layer closed after surgical resection (44%). Of those 11 patients, one developed a short-term complication, dysphagia (9%, 95% CI: 2%, 38%). Only one patient returned to the operating room, after 30 days, for an upper endoscopy after developing symptoms of gastroesophageal reflux disease. Of the 14 patients who had their muscle layer left open, 3 patients (21%, 95% CI: 8%, 48%) developed short-term complications, 2 of whom required surgical intervention within 30 days. Furthermore, 2 additional patients required surgical intervention after 30 days for a long-term complication (diverticulum and cyst recurrence).
Conclusion: Surgical complications occurred more frequently in patients who had the muscle layer left open after resection of an esophageal duplication cyst. Additionally, the majority of patients requiring re-operation for both short-term and long-term complications occurred in this group. Though small, this study is the first to evaluate the complications after resecting esophageal duplication cysts. Our results suggest that closing the esophageal muscle layer following removal of an esophageal duplication cyst may be indicated to prevent both complications and the need for reoperations.