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Esophageal atresia. A 41-year experience
Insights
Survival rates for infants with esophageal atresia have significantly improved over four decades, reaching 68% in the last ten years. However, high-risk infants still face considerable mortality due to associated conditions.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Anomalies
Background:
- Esophageal atresia (EA) is a congenital condition requiring surgical repair.
- Long-term outcomes for EA repair have historically varied.
- Improvements in surgical techniques and neonatal care may impact survival rates.
Purpose of the Study:
- To evaluate the trends in treatment outcomes for esophageal atresia over time.
- To assess survival rates and complication frequencies across different decades.
- To identify factors influencing mortality in infants with EA.
Main Methods:
- Retrospective analysis of 365 infants treated for esophageal atresia (EA) with or without tracheoesophageal fistula (TEF).
- Patients were divided into four equal time periods (decades) for outcome comparison.
- Mortality rates were analyzed based on risk groups (A, B, C) in the most recent decade.
Main Results:
- Overall late survival improved from 36-53% to 68% over four decades.
- In the last decade, mortality was 3% for group A, 5% for group B, and 41% for group C infants.
- Anastomotic leaks and recurrent fistulas occurred in approximately 5% of cases across all decades.
- Postoperative stricture was observed in 20% of the entire patient series.
Conclusions:
- Surgical repair of esophageal atresia has shown significant long-term survival improvements.
- Associated anomalies and prematurity remain major contributors to mortality in high-risk infants.
- While complications like leaks and strictures persist, esophageal replacement has not been necessary.
Abstract:
Since the first attempted repair in 1935, a total of 365 infants have undergone treatment for esophageal atresia with or without tracheoesophageal fistula. To evaluate the improvement in our results, we have divided our patients into four, approximately equal, time periods. The overall late survival has indeed improved during each of the four decades from between 36% and 53% to 68% in the last ten years. During this past decade, the group A risk infants (35 patients) had a 3% mortality, the group B (20 patients) had a 5% mortality, but the group C babies (22 patients) had a 41% mortality due to associated anomalies or severe prematurity. Anastomotic leaks and recurrent fistulas were each encountered in approximately 5% of the cases in all decades. Postoperative stricture has been encountered in 20% of the entire series and no esophageal replacements have been required.