[Surgical treatment of esophageal atresia--6 years of experience]

Surgical treatment of fourteen infants with esophageal atresia over the past six years was reviewed retrospectively. Two patients had esophageal atresia without tracheoesophageal fistula (Gross Type A), the other 12 patients had distal tracheoesophageal fistula (Gross Type C). Associated anomalies were found in three patients: one had a patent ductus arterious, another had trisomy 18, and the third had polydactylia. According to Waterston's risk group classification, there were 7 cases in Group A, 5 in Group B and 2 in Group C. The choice of operative method mainly depended on the distance between the two esophageal ends. Two patients with Type A atresia were treated by a staged operation because the distance between the two esophageal blind ends far exceeds 2 cm. A Type C patient with a "gap" longer than 2 cm who first had his esophagostomy, gastrostomy and ligation of the tracheoesophageal fistula at another hospital was transferred to us to get an esophageal reconstruction using a right-side ileocolon. Another ten Type C patients with a "gap" of less than 2 cm were operated on by extrapleural end-to-end esophago-esophagostomy after their tracheo-esophageal fistula was closed. The remaining Type C patient with a longer gap of about 3 cm was treated by primary anastomosis following mobilization of the upper pouch as well as limited mobilization of the lower esophageal segment. Anastomotic leakage was found in three patients. One patient developed subsequent stricture when the leakage was healed. The causes of mortality in three patients were pulmonary hemorrhage, sepsis and pneumonia respectively.(ABSTRACT TRUNCATED AT 250 WORDS)