TWENTY FIVE YEARS OF INTERACTION WITH ESOPHAGEAL ATRESIA AND TRACHEO-ESOPHAGEAL FISTULA

Area of Science:

• Pediatric Surgery
• Congenital Anomalies

Background:

• Esophageal atresia and tracheo-esophageal fistula are complex congenital anomalies requiring specialized surgical care.
• Long-term data on clinical presentation and management outcomes in developing regions are crucial for improving patient care.

Purpose of the Study:

• To retrospectively analyze the clinical presentation and management of esophageal atresia and/or tracheo-esophageal fistula.
• To evaluate trends in incidence, associated anomalies, operative mortality, and postoperative complications over 25 years.
• To identify factors influencing outcomes and compare survival rates with developed countries.

Main Methods:

• Retrospective analysis of 585 patients with esophageal atresia and/or tracheo-esophageal fistula.
• Data collected over 25 years (1972-1996) and divided into five-year phases.
• Evaluation of incidence, associated anomalies, operative mortality, postoperative complications, and survival rates.

Main Results:

• A steady increase in incidence and associated anomalies was observed, attributed to improved diagnostic facilities.
• Operative mortality significantly declined from 95% to 40% over the study period.
• Postoperative complications included anastomotic leaks (21%), strictures (8%), and recurrent fistulas (1%).
• Severe associated anomalies, prematurity, pulmonary complications, and sepsis were major causes of mortality.
• Survival rates for Waterston's risk group A improved to 86% in the last decade, but remained lower than in developed countries.

Conclusions:

• Early detection and referral have positively impacted outcomes by reducing pulmonary complications.
• Despite improvements, significant disparities in survival rates persist compared to developed nations.
• Addressing factors like associated anomalies and sepsis is critical for further improving outcomes in resource-limited settings.