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At least 19 recordsLinked to original sources
PubMed1998

Delayed primary repair of esophageal atresia with tracheoesophageal fistula: is it worth the wait?

OBJECTIVE: To characterize a successful approach to the management of infants with long-gap esophageal atresia (EA) with tracheoesophageal fistula (TEF), significant prematurity with respiratory distress syndrome (RDS), or both, so as to preserve the native esophagus. DESIGN: A review of the medical records and office charts of a cohort of patients with EA and TEF. SETTING: A tertiary care children's hospital affiliated with a major university. PATIENTS: A total of 118 children with EA and TEF admitted from February 1986 through December 1996. All of the patients diagnosed as having EA and TEF during this period were included. INTERVENTION: Of the 118 infants, 88 received primary repair of EA and TEF within 48 hours of birth. An additional 23 children had the TEF divided and a gastrostomy placed secondary to (1) severe RDS and prematurity (n = 6), (2) long-gap EA (gap length > 4 cm or the upper pouch above the thoracic inlet (n = 10), or (3) associated cardiac defects (n = 7). Delayed primary EA repair was done when the RDS resolved or the gap length was 2 cm or less. MAIN OUTCOME MEASURES: Successful anastomosis of native esophagus. Comparison of incidence of gastroesophageal reflux, anastomotic complications, or survival between groups undergoing primary or delayed repair. RESULTS: Primary EA was accomplished in 88 patients. Delayed EA was successfully accomplished in 18 of the 19 surviving patients within 5 months, thereby preserving the native esophagus in all surviving infants. There was no difference in anastomotic complications, gastroesophageal reflux, or survival when the delayed group was compared with those who had a primary repair. CONCLUSIONS: Using delayed EA repair, all children with EA and TEF, regardless of gap length, can have their esophagus preserved. The primary cause of mortality was the association of a severe cardiac anomaly with EA and TEF.

Anastomosis, Surgical↗
PubMedDate not supplied

Chronic lateral ankle instability: assessment of subjective outcomes following delayed primary repair and a new secondary reconstruction.

Chronic lateral ankle instability is a condition commonly encountered by the podiatric physician. Chronic instability usually occurs after injuries to the lateral collateral ligamentous complex. The purpose of this article is to report subjective results of a retrospective study comparing delayed primary ligamentous repair and a new secondary ligamentous reconstruction. Our patient population includes 23 patients who responded to a detailed questionnaire. Three patients had bilateral ligamentous repair for a total of 26 ankles. Sixteen ankles underwent delayed primary ligamentous repair, while 10 ankles had a secondary reconstruction utilizing the authors' technique. The overall postoperative improvement was 90% in those with a delayed primary repair and 82% in those with the new secondary reconstruction. The average return to full activity for both groups was 10 weeks. Average follow-up for both groups was 12 months. The authors feel these results demonstrate that delayed primary repair and the authors' new secondary reconstruction both provide favorable clinical and surgical outcomes.

Adult↗
PubMed1991

The role of delayed primary repair in the acute management of pelvic fracture injuries of the urethra.

The principal aim of management of the ruptured urethra should be to do everything possible to reduce the long-term complication rate and this applies principally to stricture formation. By far the most difficult complication to treat is severe distraction; thus the aim of early management should be to recognise and correct severe distraction injuries. Delayed primary repair at 7 to 10 days is recommended for this problem. The aim is not to prevent a stricture occurring but to make sure that if it does occur it is easily treatable.

Adolescent↗
PubMed1997

Delayed primary repair of a kyrogenic spinal accessory nerve injury: a case report.

The course of the accessory nerve through the posterior cervical triangle is superficial and in close juxtaposition to the posterior cervical lymph node chain. These anatomic features contribute to the common occurrence of kyrogenic injury to the accessory nerve. Unfortunately, the diagnosis of this injury often is delayed because the clinical presentation may mimic shoulder impingement or adhesive capsulitis. The authors present a case with a 15-year followup of a 48-year-old woman who underwent successful delayed primary repair of an accessory nerve injury after a lymph node biopsy. Electromyographic examination is recommended at 3 weeks after a suspected accessory nerve lesion, and if evidence of trapezial denervation is present, early surgical exploration is indicated because spontaneous recovery is rare.

Accessory Nerve Injuries↗
PubMed1996

Delayed primary repair of intrathoracic esophageal perforation: is it safe?

The management of intrathoracic esophageal perforation with delayed diagnosis is a subject of controversy. Because of the obvious advantages of primary repair as a simple single-stage operation, this technique was preferentially used to treat 18 of 22 consecutive patients with esophageal perforation. These patients were stratified into three groups according to the time interval between perforation and repair: group A, less than 6 hours, five patients (28%); group B, 6 to 24 hours, six patients (33%); and group C, more than 24 hours, seven patients (39%). Group A patients were older (p < 0.05) and group B had fewer iatrogenic perforations (B, 17%; A, 80%; C, 57%, p < 0.1). Additional tissue was used to buttress the repair site in all three groups (A, 3/5 patients, 60%; B, 4/6 patients, 67%; C, 6/7 patients, 86%; p = not significant). In seven patients (39%), a fundic wrap was used to reinforce the site of primary repair. The outcomes of the three groups were analyzed. Group A had the lowest proportion of postoperative leaks (A, 0/4 patients, 0%; B, 4/6 patients, 67%; C, 5/6 patients, 83%; p < 0.05) and postoperative morbidity (A, 2/5 patients, 40%; B, 6/6 patients, 100%; C, 6/7 patients, 86%; p < 0.1). However the increased incidence of leak and morbidity did not lead to an increase in mortality. One death occurred in each group, with an overall mortality of 17% (A, 1/5 patients, 20%; B, 1/6 patients, 17%; C, 1/7 patients, 14%; p = not significant). We conclude that in the era of advanced intensive care capabilities, primary repair of intrathoracic esophageal perforation can be safely accomplished in most patients regardless of the time interval between perforation and operation. Leakage at the suture site is common unless primary repair is carried out without delay. Postoperative leakage, however, is usually inconsequential and does not necessarily result in an adverse outcome.

Aged↗
PubMed1992

Feeding troubles following delayed primary repair of esophageal atresia.

Severe feeding troubles were recorded in five babies with long-gap esophageal atresia who underwent, between 1985 and 1990, a delayed primary anastomosis after spontaneous growth of their esophageal stumps. A comparison with 20 cases of direct esophageal anastomosis, operated on in the same period, was carried out by means of recorded esophagrams, pH monitoring and questionnaires charting the growth pattern and feeding habits of the patients. Bottle feeding, and, later on, the introduction of semi-solid foods was significantly retarded in the group of children with delayed primary anastomosis (labeled as group B) as well as height and weight parameters. Failure to complete feeds, dysphagia, vomiting, coughing, choking and recurrent respiratory symptoms were also significantly more common in this group than in the primary anastomosis group (labeled as group A) even in the absence of stricture. Variable degrees of disordered esophageal motility were present in all patients but pooling of the contrast medium, retrograde flow and delayed clearing of the esophagus were more frequent in group B. No patient was shown to have associated hiatal hernia. A 24 hour pH recording showed severe gastroesophageal reflux in 4 out of 13 cases of group A and in 3 out of 5 cases of group B. Clearing times were significantly delayed in all refluxing children. Our data suggest that the retarded start of oral feeding and swallowing coordination in patients with delayed primary anastomosis add further negative factors to their congenitally impaired esophageal motility, causing protracted dysphagia which represents a major problem for both family and hospital staff.

Anastomosis, Surgical↗
PubMed1984

Current state of flexor tendon surgery.

Successful restoration of function after flexor tendon injuries continues to present a challenge to the treating surgeon. Primary repair of tendon and associated injuries is the treatment of choice in clean wounds in all zones of the hand. In cases of untidy wounds or when associated injuries preclude primary repair, delayed primary or secondary repair may be performed. Tendon grafting in one or two stages is reserved for late secondary cases in which scarring of the bed, loss of pulleys, permanent retraction of the tendon ends, or joint contractures prevent direct repair. Meticulous attention to detail such as adequate exposure, careful opening and closing of the sheath, gentle handling of the tendons, a secure, smooth tendon juncture and proper postoperative splinting is essential for a successful outcome of direct repair. Tendon grafts done as a secondary procedure require the same attention to minutiae for an adequate functional outcome.

Biomechanical Phenomena↗
PubMed1989

Current results in repair of esophageal atresia with tracheoesophageal fistula using physiologic status as a guide to therapy.

Since 1966, 118 infants with esophageal atresia associated with tracheoesophageal atresia (Vogt-Gross Type C) have been operated upon with an overall survival rate of 90% at our institution. Since Haight's first survivor in 1941, argument has continued about the relative merits of immediate repair, delayed primary repair, and staged repair, and the criteria for selection of each approach. The Waterston classification served as the foundation for selection of surgical management from 1966 to 1982. Since 1982, physiologic status has been used as the sole basis for surgical management without regard to weight, gestation, or pulmonary condition. Twenty-six patients so chosen for immediate repair have all survived. Fewer have required gastrostomy, and the average hospital stay has shown significant decrease, a reflection of improved overall care of the neonate. Thirteen infants with severe cardiopulmonary compromise had some form of staged repair in this latter period with a 77% survival rate. Our experience using a refinement of Waterston's principles has led to more and earlier primary repairs with maintenance of excellent survival rates in stable infants. A staged approach is still useful for certain severely compromised infants.

Birth Weight↗
PubMed1994

Flexor sheath closure during delayed primary tendon repair.

We studied the effect of flexor tendon sheath closure on flexor tendon function after delayed primary flexor tendon suture in white leghorn chickens. The tendon suture was carried out after a tendon laceration. In the left foot the tendon sheath was closed after tendon suture, and in the right the sheath was excised over the tendon suture. Tendon gliding, joint motion, the fate of the closed sheath, peritendinous adhesions, and tendon healing were studied. The sutured sheath disappeared after suturing and was associated with poor tendon healing. Sheath closure did not improve flexor tendon function in a delayed primary repair.

Animals↗
PubMed1990

Surgical management of the tendon sheath at different repair stages. Biomechanical and morphological evaluations of direct sheath closure, partial sheath excision, and interposing sheath grafting.

The effects of direct sheath closure, partial sheath excision, and interposing sheath grafting at different repair stages were evaluated in the chicken model. Primary repair was done after sheath incision and tendon transection, and delayed primary repair was done 4 days after sheath and tendon injuries. The sheath grafting was accomplished by interposing a patch of sheath between the longitudinal incision of the plantar sheath. Six weeks later, biomechanical tests for measuring gliding excursions of the repaired tendons, morphological examinations of the extent of adhesions, and histological observations of the closed sheath or the grafted sheath were carried out. At the primary repair stage, the sheath interposing graft achieved more significant gliding excursion than the groups of direct sheath closure (P less than 0.01) and partial sheath excision (P less than 0.001), and no difference was found between the latter two groups (P greater than 0.05). At the delayed primary repair stage, the sheath interposing graft group was better than the partial excision graft group (P less than 0.05), and the partial excision group was better than the direct closure group (P less than 0.001). The sheath graft and sheath closure at the primary repair stage prevented adhesion formation, but the directly closed sheath did not keep intact after the delayed primary repair and extensive adhesion occurred. In this paper, the importance of volume of the repaired sheath tunnel and possible reasons for results of the delayed primary sheath closure were discussed and the management of flexor tendon sheath for different injuries at different repair stages was suggested.

Animals↗
PubMed2026

Surgical management of esophageal atresia with tracheoesophageal fistula in extremely low birth weight neonates: A systematic review.

BACKGROUND: Surgical management of esophageal atresia/tracheoesophageal fistula (EA/TEF) in extremely low birth weight (ELBW) neonates remains challenging and controversial. This study systematically reviews surgical strategies and outcomes in this population. METHODS: Following PRISMA guidelines, Cochrane, Embase, MEDLINE, Scopus, and Web of Science (2004-2024) were searched in February 2025 for studies on surgical management of ELBW neonates with EA/TEF (PROSPERO CRD42025636228). Fatal chromosomal abnormalities were excluded. Demographics, comorbidities, surgical techniques, and complications were analyzed descriptively. Risk of bias was assessed. RESULTS: Eleven publications (five case reports and six case series) comprising 30 patients (Gross type B/C = 1/29) met the eligibility criteria. Mean gestational age was 28.1 (23-34) weeks, and mean birth weight was 760.4 (422-995) g. Twelve primary repairs (PR) and 18 delayed primary repairs (DPR) were performed, including staged repair (n = 11), lower esophageal banding (n = 4), and other techniques (n = 3). Postoperatively, four anastomotic leaks were managed conservatively, six strictures and one recurrent TEF required endoscopic intervention, three fundoplications and two aortopexies were reported (follow-up: 1-198 months, n = 19). Overall mortality was 30% (PR: 8.3%; DPR: 44.4%). Mortality was 60% among neonates with major congenital heart defects (CHD) and 40% among those with VACTERL association. EA/TEF-related complications contributed to 33.3% of deaths. CONCLUSIONS: Mortality in this cohort remains high, particularly with major CHD, and is largely unrelated to EA/TEF-specific complications. In selected cases, PR appears feasible as an alternative to DPR, although conclusions are limited by the small sample size and heterogeneous studies.

Humans↗
PubMed1990

Tracheo-oesophageal fistula and pre-operative mechanical ventilation.

Twelve patients with tracheo-oesophageal fistula (TOF) and restrictive lung disease necessitating pre-operative ventilation are reported. Eight patients had respiratory distress syndrome, four had aspiration pneumonia, and 11 had associated oesophageal atresia. Two patients in whom a preliminary gastrostomy was performed died. Emergency ligation of the fistula was performed in 10 patients, nine of whom survived. Following division of the fistula, respiratory function improved dramatically in three patients and primary oesophageal repair was performed. Three patients underwent delayed primary repair and the oesophagus was sacrificed, with a view to replacement at a later date, in the remaining three patients. We believe that the presence of a TOF in a neonate with poorly compliant lungs requiring mechanical ventilation represents a serious surgical challenge. Gastrostomy alone should never be performed. Ligation of the fistula with either immediate or delayed primary repair of the oesophagus are the treatments of choice.

Esophagus↗
PubMed1982

Flexor tendon repair in the neonate.

Primary or delayed primary repair of flexor tendon lacerations in the digital sheath has become the accepted practice among surgeons expert in the treatment of hand injuries. The youngest patient reported in the literature we reviewed was 3 months old. We report a case of flexor tendon laceration at the time of delivery by emergency cesarean section. Delayed primary repair was carried out ten days later. Five months following surgery, functional results were judged to be good to excellent. The operating microscope is a valuable adjunct for tendon repair in the neonate. The procedure should be done by an experienced hand surgeon on an elective basis in a medical center where operating room personnel and anesthesia staff are familiar with neonatal patients. Under such conditions an excellent result can be obtained with a single definitive procedure.

Birth Injuries↗
PubMed1985

Ankle instability: comparison of primary repair and delayed reconstruction after long-term follow-up study.

Twenty-five consecutive primary ligament repairs and 40 delayed reconstructions for lateral collateral ankle ligament injuries were studied. Response to a questionnaire provided a 94% subjective evaluation at a mean of 9.5 years after surgery; 97% of patients were satisfied with the surgical result. Clinical examination, stress radiography, and biomechanical gait analysis studies were performed on 39 patients at four years or more after surgery (mean, 9.6 years). In 14% of those with ligament repair and 41% of those with reconstructive procedures, mean residual talar tilt with stress testing was 3.2 degrees and 5.2 degrees, respectively. Gait studies did not demonstrate a consistent abnormal gait pattern, even with side slope walking, and did not correlate with the talar tilt values. There was no significant measurable difference between the results of repair and reconstruction. Thus, most severe Grade III sprains can be managed nonoperatively, and if late residual instability occurs, a reconstructive procedure can be offered with confidence that the result will be equivalent subjectively and roughly comparable objectively to that of the immediate repair.

Adolescent↗
PubMed1985

Nerve grafting. Functional results after primary vs delayed repair.

The finding of heightened metabolic activity in nerve cell bodies after axonal injury has led to speculation that delaying motor nerve repair would be beneficial. Using a sciatic nerve model, 100 rats were grouped based on nerve autograft donor and recipient site variables. Animals were subjected to electrophysiologic testing at 3, 6, 9, and 12 weeks after grafting. Twitch force and nerve compound action potential parameters were calculated and compared using two-way analysis of variance. Previous studies have suggested interaction between donor and recipient variables. We cannot support these findings. Our data revealed no significant difference between immediate or delayed nerve repair or between fresh or predegenerated nerve grafts.

Action Potentials↗
PubMed1980

Repair and healing of the divided digital flexor tendon.

A series of 275 repairs is reviewed. Primary or delayed primary repair of the divided digital flexor tendon is advocated. Preoperative splinting and careful operative technique to avoid damage to the blood supply of the divided tendon are necessary. The tendon repair is followed by closure of the fibrosynovial sheath and postoperative splintage. By this means acceptable results are obtained.

Adolescent↗