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Experience in treating congenital esophageal atresia in China
Zhibo Zhang1, Ying Huang, Pengjun Su
1Shengjing Hospital of China Medical University, Shenyang 110003, China. cathyzbzhang@sina.com
Insights
This study evaluated esophageal atresia (EA) treatment outcomes. Most infants with EA experience good surgical results, with complex cardiac anomalies and pneumonia being key mortality factors.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Thoracic Surgery
Background:
- Esophageal atresia (EA) is a congenital condition requiring surgical intervention.
- Understanding treatment outcomes is crucial for improving patient care.
Purpose of the Study:
- To assess the recent surgical management and outcomes of esophageal atresia (EA) at a single pediatric surgery center.
- To identify factors influencing mortality and complications in EA patients.
Main Methods:
- Retrospective review of infant records with EA from 2006 to 2009.
- Analysis of birth weight, associated anomalies, surgical management, complications, and patient outcomes.
- Evaluation of the utility of preoperative computed tomographic (CT) imaging and 3D reconstruction.
Main Results:
- Forty-eight infants with EA were treated; 12.5% mortality was observed.
- Common associated anomalies included cardiac defects and imperforate anus.
- Pneumonia, anastomotic leakage, and gastroesophageal reflux were significant complications.
Conclusions:
- Esophageal atresia (EA) surgery generally yields excellent short- to midterm outcomes.
- Complex cardiac anomalies, aspiration, and pneumonia are primary mortality determinants.
- CT imaging aids surgical planning; most complications are managed conservatively.
Purpose:
The aim of the study was to evaluate our recent experience in treating esophageal atresia (EA) and the outcomes observed at a single center for pediatric surgery.
Materials And Methods:
The records of infants with EA from 2006 to 2009 were reviewed. Birth weight, associated anomalies, details of management, complications, and outcomes were examined.
Results:
Forty-eight consecutive infants with EA were identified from 2006 to 2009, of which 33 (69%) were boys. Mean birth weight was 2668 g (range, 1700-3800 g). Common associated malformations (35%) were cardiac anomalies, imperforate anus, limb anomalies, and chromosomal anomalies. Forty-seven were Gross type C, and one was Gross type A. Forty-five infants underwent ligation of the tracheoesophageal fistula and end-to-side primary anastomosis, and one received a colonic interposition. Six patients died (12.5% mortality). Three died before or during operation because of severe pneumonia and complex cardiac anomalies, and 3 died during recovery (within 1 month after repair) because of aspiration and severe pneumonia (early postoperative mortality was 6.67%). Complications included pneumonia, anastomotic leakage (16%, all recovered after conservative treatment), wound sepsis (11%), recurrent tracheoesophageal fistula (9%) (3/4 recovered after conservative treatment), anastomotic stricture (10%), and gastroesophageal reflux in about 2 of 3 patients. Preoperative computed tomographic imaging and 3-dimensional graphic reconstruction used in 15 patients were useful.
Conclusions:
Most patients with EA have excellent short- to midterm surgical outcomes. The main factors for mortality are complex cardiac anomalies, aspiration, and pneumonia. Computed tomographic imaging and 3-dimensional graphic reconstruction can provide surgeons with excellent preoperative reference about the anatomy of the defect. Most anastomotic related complications resolve with conservative treatment. Patients of low-risk prognosis group with type A and long gap EA can be managed with a primary colonic interposition with good results. The main midterm complications are gastroesophageal reflux and stricture.
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