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Esophageal atresia in Osaka: a review of 39 years' experience
1The Department of Pediatric Surgery, Osaka University Medical School and Osaka Prefectural Medical and Research Institute for Mother and Child Health, Suita, Japan.
Insights
Esophageal atresia survival has improved significantly due to better care, but complications like strictures and reflux remain common. Advances in perinatal care and early diagnosis are key to managing these challenging pediatric surgical cases.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Malformations
Background:
- Over 159 patients with esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) treated since 1957.
- Long-term survival improved from 28% (1957-1967) to 80% (1980-1995).
Purpose of the Study:
- To analyze long-term outcomes and complications in patients with EA/TEF.
- To evaluate the effectiveness of different risk stratification systems.
Main Methods:
- Chronological division of 159 EA/TEF cases into three periods.
- Analysis of associated anomalies, including VATER/VACTER association.
- Comparison of Waterston and Spitz classification systems for survival prediction.
Main Results:
- Survival rates improved significantly over 39 years.
- Associated anomalies were common (65.2%), with cardiovascular and gastrointestinal malformations most frequent.
- Spitz classification showed better survival differentiation (92% group 1, 50% group 2, 0% group 3) compared to Waterston.
- High incidence of postoperative complications: anastomotic leakage (26.5%), stricture (49.1%), and gastroesophageal reflux (52.0%).
Conclusions:
- Improved survival in EA/TEF is linked to advances in perinatal care and surgical techniques.
- Early recognition of conditions like tracheomalacia and gastroesophageal reflux is crucial.
- Despite improvements, postoperative complications remain a significant challenge.
Background:
One hundred fifty-nine patients who had esophageal atresia with or without tracheoesophageal fistula have been treated at Osaka University Medical School and its affiliated hospitals since the initial (Japanese) experience of Dr T. Ueda in 1957.
Methods:
These cases were divided chronologically into three groups. With earlier recognition of surgical neonates and the development of perinatal care, the long-term survival of these patients has steadily improved over 39 years from 28% in the first period (1957 to 1967) to 80% in the third period (1980 to 1995). Of 141 patients treated in the second and third periods (1968 to 1995), 92 (65.2%) had associated anomalies. Cardiovascular and gastrointestinal malformations were the most frequently seen major anomalies. VATER or VACTER association was seen in 12.8% (18 of 141) of these patients. Survival of these cases according to Waterston risk factors was 100% for group A, 100% for group B, and 50% for group C, whereas the new classification proposed by Spitz showed survival of 92% for group 1, 50% for group 2, and 0% for group 3, showing better differentiation among the three groups.
Results:
There was a long gap between the proximal and distal esophageal ends in seven patients (type A), in all of whom primary anastomosis was possible after 28 to 128 days of elongation by bouginage. Although the survival of esophageal atresia patients dramatically improved in recent years, there is still a high incidence of early and long-term postoperative complications, ie, anastomotic leakage (26.5%), recurrent fistula (7.2%), anastomotic stricture (49.1%), postoperative pneumonia or atelectasis (57.0%), tracheomalacia (25.8%), and gastroesophageal reflux (52.0%).
Conclusions:
Recently, there have been changing patterns in the occurrence of complications, which are mainly attributed to technical improvement, better perinatal care and early recognition of pathophysiologic conditions such as tracheomalacia and gastroesophageal reflux.