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Feeding troubles following delayed primary repair of esophageal atresia
S Cavallaro1, A Pineschi, G Freni
1Department of Pediatric Surgery, Regina Margherita Children's Hospital, Torino, Italy.
Insights
Delayed primary anastomosis in esophageal atresia infants led to significant feeding difficulties and growth delays. These infants experienced more swallowing problems and respiratory issues compared to those with direct anastomosis.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Developmental Biology
Background:
- Long-gap esophageal atresia presents significant surgical challenges.
- Delayed primary anastomosis is a surgical approach for specific esophageal atresia cases.
- Esophageal motility disorders are common in congenital esophageal anomalies.
Purpose of the Study:
- To compare feeding outcomes and growth in infants with long-gap esophageal atresia treated with delayed versus direct primary anastomosis.
- To evaluate the impact of surgical timing on swallowing function, esophageal motility, and gastroesophageal reflux.
- To identify long-term consequences of delayed anastomosis on infant development.
Main Methods:
- Retrospective comparison of two groups of infants with long-gap esophageal atresia (delayed anastomosis, n=5; direct anastomosis, n=20).
- Data collection via esophagrams, 24-hour pH monitoring, and questionnaires on growth and feeding.
- Assessment of feeding patterns, growth parameters (height, weight), and clinical symptoms (dysphagia, vomiting, respiratory issues).
Main Results:
- Infants in the delayed anastomosis group (Group B) showed significantly retarded bottle feeding, introduction of solids, height, and weight parameters.
- Group B experienced more frequent feeding difficulties, dysphagia, vomiting, coughing, choking, and recurrent respiratory symptoms compared to Group A.
- Esophageal motility was impaired in all patients, with more pooling, retrograde flow, and delayed clearing in Group B. Severe gastroesophageal reflux was noted in both groups, with delayed clearing times in refluxing children.
Conclusions:
- Delayed primary anastomosis in long-gap esophageal atresia exacerbates congenital esophageal motility deficits.
- This approach leads to protracted dysphagia, impacting infant feeding, growth, and overall well-being.
- The findings highlight the significant challenges faced by families and healthcare providers managing these complex cases.
Abstract:
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.