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An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Outcome in neonates with esophageal atresia treated over the last 20 years
Helene Engstrand Lilja1, Tomas Wester
1Department of Pediatric Surgery, University Hospital, SE-751 85, Uppsala, Sweden. helene.lilja@surgsci.uu.se
Insights
Improved survival rates for infants with esophageal atresia (EA) were observed over two decades, despite an increase in major cardiac defects. Long-term gastrointestinal and respiratory symptoms remain common in these patients.
Area of Science:
- Pediatric Surgery
- Neonatology
- Congenital Anomalies
Background:
- Esophageal atresia (EA) is a congenital condition requiring surgical intervention.
- Outcomes for EA have evolved with advancements in surgical techniques and neonatal care.
- Long-term follow-up is crucial for managing associated complications and comorbidities.
Purpose of the Study:
- To evaluate the changes in outcomes for infants with esophageal atresia (EA) over two decades (1986-2005).
- To compare survival rates, complication incidence, and long-term functional status between two distinct treatment periods.
- To identify factors influencing outcomes and highlight the importance of ongoing management.
Main Methods:
- Retrospective review of medical records for 147 infants treated for EA between 1986 and 2005.
- Division of patients into two cohorts: 1986-1995 and 1996-2005.
- Patient interviews (n=125) to assess gastrointestinal function, respiratory symptoms, and educational attainment.
Main Results:
- Overall survival increased from 87% to 94%, with improved survival across all EA severity groups (Spitz classification).
- The incidence of major cardiac defects rose from 23% to 29%.
- Anastomotic strictures increased slightly (53% to 59%), while leakage and recurrent fistula rates remained stable. Primary anastomosis rates improved (78% to 85%).
- Long-term, 40-50% of patients experienced gastrointestinal and respiratory symptoms, though 90% attended normal school.
Conclusions:
- Despite an increase in complex cardiac anomalies, survival rates for esophageal atresia have significantly improved.
- Gastrointestinal and respiratory issues are frequent long-term sequelae requiring continued management.
- Optimized surgical approaches and comprehensive long-term follow-up are essential for improving the quality of life for EA patients.
Abstract:
We evaluated the outcome in infants with esophageal atresia (EA) treated in our department over the last two decades. The medical records of 147 infants treated from 1986 to 2005 were reviewed. Patient characteristics, associated anomalies, surgery and complications were recorded. We divided the material into two time-periods: 1986-1995 and 1996-2005; 125 patients or parents were interviewed regarding gastrointestinal function, respiratory symptoms and education. The incidence of major cardiac defects increased from 23 to 29% and the overall survival increased from 87 to 94%. Using Spitz' classification survival increased from 93.5 to 100% in group I and from 68.4 to 77.8% in group II. In group III, during the second time period, survival was 100% in three patients. The incidence of anastomotic leakage and recurrent fistula did not change over time. The rate of anastomotic strictures increased from 53 to 59% between the two time-periods. A primary anastomosis could be done in 85% of the patients during the second period versus 78% of the patients during the first period. Anti-reflux surgery was done in only 11 and 9%, respectively, during the two time-periods. In patients who were 16-20 years old, 40-50% had gastrointestinal and respiratory symptoms. Ninety percent of the patients attended normal school. The major difference between the periods 1986-1995 and 1996-2005 was an increased survival despite an increased incidence of major cardiac defects. Gastrointestinal and respiratory symptoms were frequent. Long-term follow-up and treatment of complications of esophageal atresia is important for this patient group.
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