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Esophageal atresia: tragedies and triumphs over two decades in a developing country
A K Sharma1, A K Shukla, G Prabhakar
1Department of Pediatric Surgery, SMS Medical College & Attached SPMCHI, Jaipur, India.
Insights
Pediatric surgery outcomes for esophageal atresia and tracheo-esophageal fistula improved significantly over two decades in India. Early diagnosis and better care increased survival rates, despite challenges in developing countries.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Surgical Outcomes
Background:
- Esophageal atresia and tracheo-esophageal fistula are complex congenital conditions requiring specialized surgical management.
- A significant proportion of patients present with high-risk factors (Waterston's category C).
- Management challenges are particularly pronounced in resource-limited settings.
Purpose of the Study:
- To evaluate the trends and outcomes of surgical management for esophageal atresia and tracheo-esophageal fistula over a 20-year period.
- To identify factors contributing to improved survival rates.
- To highlight challenges faced in developing countries.
Main Methods:
- Retrospective analysis of 303 patients treated between 1972 and 1991.
- Patients divided into four 5-year phases to assess temporal changes.
- Evaluation of surgical techniques, perioperative care, and associated anomalies.
Main Results:
- A notable increase in diagnosed cases and associated anomalies over the study period.
- Improved survival rates from 4.6% (1972-76) to 45.7% (1987-91).
- Decreasing trends in postoperative pulmonary complications and anastomotic leaks.
Conclusions:
- Early diagnosis, improved perioperative care, and modern antibiotics have significantly enhanced survival.
- Severe associated anomalies, pulmonary complications, and sepsis remain critical challenges.
- Surgical outcomes in developing countries, while improving, still lag behind developed nations, necessitating focus on practical management strategies.
Abstract:
During a period of two decades, 1972-1991, 303 patients with esophageal atresia and/or tracheo-esophageal fistula were treated at the department of Pediatric Surgery, SMS Medical College, Jaipur, India. More than half of our patients fall into Waterston's risk category C. To evaluate the improvement in our results, the patients were divided into four phases of 5 years each. Over the period of observation, the incidence of new cases as well as the number of associated anomalies has considerably increased. With time, more patients are being diagnosed and referred early for treatment. This has resulted in more patients being treated by primary repair with or without a gastrostomy. Extrapleural approach and single layer end-to-end anastomosis has been practised in all cases. Results have shown a steady improvement primarily because of early recognition, improved perioperative care and newer antibiotics. Although postoperative pulmonary complications and anastomotic leak have shown a decreasing trend, but the presence of severe associated anomalies, pulmonary complications and sepsis still remain the major killers in our set-up. Although our results may not match those from the developed countries, we have still come a long way, improving our overall survival rate of 4.6% in 1972-76 to 45.7% in 1987-91. Through the present article, we wish to highlight the practical problems faced in the management of these patients in underprivileged developing countries.