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Optimal Surgical Method and Timing for Low-birth-weight Esophageal Atresia Babies: Multi-institutional Observational
Toru Shimizu1, Shigeru Takamizawa2, Toshihiro Yanai3
1University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 9030215, Japan; Nagano Children's Hospital, Japan.
Insights
Low birth weight infants with esophageal atresia benefit from definitive esophageal anastomosis, whether performed initially or after weight gain. This surgical repair improves survival rates in neonates with this congenital anomaly.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Congenital Anomalies
Background:
- Low birth weight is a known risk factor for esophageal atresia.
- Evidence regarding optimal timing and surgical techniques for esophageal atresia in low birth weight infants is limited.
Purpose of the Study:
- To investigate the effectiveness of definitive esophageal anastomosis in low birth weight infants (birth weight ≤1500 g).
- To analyze the impact of surgical timing and associated anomalies on outcomes for esophageal atresia.
Main Methods:
- A multi-institutional observational study involving 11 hospitals.
- Data collected from 2001 to 2020 on esophageal atresia patients with birth weights ≤1500 g.
- Analysis of 46 patient cases focusing on surgical timing and outcomes.
Main Results:
- Of 46 infants, 19 (41%) underwent definitive esophageal anastomosis within the first month.
- Seven infants underwent anastomosis after one month to achieve adequate weight gain.
- Infants not receiving anastomosis had a significantly higher mortality rate (78%), particularly those with major cardiac or chromosomal anomalies.
Conclusions:
- Definitive esophageal anastomosis is effective in low birth weight infants, regardless of whether it's performed as an initial procedure or delayed for weight gain.
- Palliative surgical treatments may be considered for infants with severe anomalies, with subsequent surgical decisions based on individual patient condition.
Aim Of The Study:
Previous research has shown that low birth weight is one of the risk factors for esophageal atresia. However, there remains a paucity of evidence on the timing and the treatment method.
Method:
Data were collected using a multi-institutional observational study in 11 hospitals that performed surgeries on esophageal atresia babies whose birth weights were ≤1500 g from 2001 to 2020.
Results:
Of the 46 patients analyzed, median birth weight was 1233 (IQR 1042-1412) g. Within 46 cases, 19 (41%) underwent definitive esophageal anastomosis at the median of age in 8 (IQR 2-101) days. Thirteen out of 19 experienced either closure of tracheoesophageal fistula, gastrostomy, or esophageal banding at the first operation, followed by esophageal anastomosis. Seven infants, including four cases of <1000 g, underwent anastomosis after one month of age to wait for weight gain (variously 2-3000 g). Twenty-one out of 27 infants (78%) who did not receive anastomosis died within one year of age, including 21 (78 %) with major cardiac anomalies and 24 (89%) with severe chromosomal anomalies (trisomy 18). Six survivors in this group, all with trisomy 18, lived with palliative surgical treatments.
Conclusion:
In our study, the definitive esophageal anastomosis was effective either at the first operation or as a later treatment after gaining weight. Although having severe anomalies, some infants receive palliative surgical treatments, and the next surgery was considered depending on their condition.
Evidence Level:
II.
