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[Modern trends in the treatment of esophageal atresia]
1Cattedra di Chirurgia Generale I, Scuola di Specializzazione in Chirurgia Pediatrica, Università degli Studi G. D'Annunzio di Chieti, Sede di Pescara.
Insights
Surgical outcomes for esophageal atresia have improved, with primary repair now possible for many newborns. Survival rates are high, particularly for less complex cases, but associated malformations significantly impact outcomes.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Malformations
Context:
- Esophageal atresia treatment has seen significant advancements over the past two decades.
- Primary surgical correction at birth is increasingly feasible for neonates.
- A cohort of 64 neonates with esophageal atresia (December 1982-December 1995) was analyzed.
Purpose:
- To evaluate the outcomes of surgical treatment for esophageal atresia in neonates.
- To assess the impact of associated malformations and preoperative risk classification on survival.
- To analyze the incidence and management of postoperative complications.
Summary:
- The study observed 64 neonates with esophageal atresia, with 55% having associated malformations, most commonly congenital cardiopathies.
- Primary esophageal anastomosis was performed in 80% of cases, with an overall survival rate of 80%.
- Survival was strongly correlated with the absence of severe multiple congenital anomalies, rather than bronchopneumonic complications or birth weight.
Impact:
- Improved surgical techniques and early intervention contribute to better outcomes in esophageal atresia management.
- Early identification and management of associated malformations are crucial for improving survival rates.
- This study highlights the importance of a multidisciplinary approach in optimizing care for neonates with esophageal atresia.
Abstract:
Results in the treatment of oesophageal atresia have greatly improved in the last 20 years. In an increasing number of patients it is possible to practice primary surgical correction at birth. From December '82 to December '95, 64 neonates with oesophageal atresia ranging in weight from 1.2 to 3.8 kg were observed. Fifty-eight neonates had type III atresia, four had type I atresia and two presented a rare membranous atresia with a long longitudinal intramural fistula. Fifty-four associated malformations were present in thirty-five neonates (55%). Congenital cardiopathies were the most frequent malformations followed by ano-rectal, skeletal and urinary malformations. According to the classification proposed by Waterston, 35% of the neonates were Class A, 33% Class B, and 32% Class C. Three neonates with polymalformations died before surgical treatment. Our trend is to attempt, when possible, primary correction using an extrapleural approach, even in the presence of a long gap. Oesophageal anastomosis was performed in 51 patients (80%). Gastrostomy was never performed routinely but only in selected cases. Early post-operative complications occurred in 22.5% of the cases. Gastroesophageal reflux, registered in 11 cases, was treated surgically in 4 cases. All 13 cases of post-anastomotic stenosis were treated with cycles of dilatations. The overall survival rate in 64 patients was 80% (96% in Class A; 86% in Class B, 55% in Class C). Of the 51 patients who underwent oesophageal anastomosis only 3 died, one because of the risk category according to Waterston. Survival is related more to the presence of severe multiple associated malformations, rather than bronchopneumonic complications of birth weight.