Trends in tracheoesophageal fistula

The changing trends in the management of patients with esophageal atresia, with or without tracheoesophageal fistula during 1974 to 1983, and its effect on survival and morbidity rates are analyzed herein. Of 139 patients in this series, 44 per cent were in Waterston group C. The over-all mortality rate was 25.5 per cent but this decreased consistently after 1980 to 11.0 per cent in 1983. The incidence of infants in the series who weighed less than 1.8 kilograms at birth increased from 7 per cent before 1979 to 18 per cent after 1979 and the survival rate increased from zero to 50 per cent. All six infants who were 30 to 34 weeks gestation and referred after 1979 survived. Severe pneumonia at admission decreased from 24 to 11 per cent in two five year periods. Delayed primary anastomosis and Livaditis circular myotomy overcame many problems of the "long gap" associated with pure esophageal atresia, resulting in successful anastomosis in all eight patients treated in the latter years. Of six patients who presented before 1979, three patients died and three required interposition grafts. Significant anastomotic leaks decreased from 14.7 to 3.2 per cent and the mortality rate decreased from 70 to zero per cent, reflecting many factors, such as extrapleural repair, use of total parenteral nutrition and improved neonatal, ventilatory and intensive care.