Esophageal atresia: five year experience with 148 cases

Area of Science:

• Pediatric Surgery
• Neonatology
• Congenital Abnormalities

Background:

• Esophageal atresia with tracheoesophageal fistula is a complex congenital anomaly requiring surgical intervention.
• Outcomes are influenced by associated anomalies, prematurity, and surgical technique.
• Risk stratification aids in predicting survival and guiding management.

Purpose of the Study:

• To review surgical outcomes for esophageal atresia with distal tracheoesophageal fistula.
• To identify factors influencing survival and complications.
• To evaluate specific surgical and management strategies.

Main Methods:

• Retrospective review of 148 infants treated over a 5-year period.
• Analysis of survival rates based on preoperative risk groups (A, B, C).
• Evaluation of complication rates, including anastomotic leaks, strictures, and recurrent fistulas.

Main Results:

• 87% of cases were esophageal atresia with distal tracheoesophageal fistula.
• Survival rates were 100% (Group A), 86% (Group B), and 73% (Group C).
• Complications included anastomotic leaks (21%), strictures (18%), and recurrent fistulas (12%). Braided silk use correlated with higher complications.
• Delayed surgery for aspiration pneumonia and preoperative endoscopy showed distinct advantages.
• Congenital cardiac anomalies were the leading cause of mortality.

Conclusions:

• Mortality is directly related to the severity of associated congenital anomalies, particularly cardiac defects.
• Delayed surgical repair pending improvement of aspiration pneumonia and elective postoperative ventilatory support for tense anastomoses are beneficial.
• Aggressive management of severe gastroesophageal reflux and tracheomalacia is crucial.
• Routine gastrostomy offered no advantages; emergency fistula ligation is preferred in severe respiratory distress.