Esophageal atresia associated with anorectal malformation: Is the outcome better after surgery in two stages in a limited resources scenario?

Esophageal atresia associated with anorectal malformation: Is the outcome better after surgery in two stages in a limited resources scenario?

To analyze whether outcome of neonates having esophageal atresia with or without tracheoesophageal fistula (EA±TEF) associated with anorectal malformation (ARM) can be improved by doing surgery in 2 stages. A prospective study of neonates having both EA±TEF and ARM from 2004 to 2011. The patients wi...

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Published in:Journal of Indian Association of Pediatric Surgeons Vol. 17; no. 3; pp. 107 - 110
Main Authors: Singh, Sunita, Wakhlu, Ashish, Pandey, Anand, Singh, Anita, Kureel, Shiv N, Rawat, Jiledar, Srivastava, Payal Mishra
Format: Journal Article
Language:English
Published: India Medknow Publications and Media Pvt. Ltd 01-07-2012
Medknow Publications & Media Pvt. Ltd
Medknow Publications & Media Pvt Ltd
Wolters Kluwer Medknow Publications
Subjects:
Abdomen
Anorectal malformation
Developing countries
esophageal atresia
Infants (Newborn)
LDCs
Medical research
Medicine, Experimental
Mortality
neonatal intensive care
Nutrition
Original
Ostomy
Parenteral nutrition
Pneumonia
Regression analysis
Respiratory distress syndrome
Sepsis
Surgery
tracheoesophageal fistula
Ventilators
neonatal intensive care
esophageal atresia
tracheoesophageal fistula
Anorectal malformation
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Summary:To analyze whether outcome of neonates having esophageal atresia with or without tracheoesophageal fistula (EA±TEF) associated with anorectal malformation (ARM) can be improved by doing surgery in 2 stages. A prospective study of neonates having both EA±TEF and ARM from 2004 to 2011. The patients with favorable parameters were operated in a single stage, whereas others underwent first-stage decompression surgery for ARM. Thereafter, once septicemia was under control and ventilator care available, second-stage surgery for EA±TEF was performed. Total 70 neonates (single stage = 20, 2 stages = 30, expired after colostomy = 9, only EA±TEF repair needed = 11) were enrolled. The admission rate for this association was 1 per 290. Forty-one percent (24/70) neonates had VACTERL association and 8.6% (6/70) neonates had multiple gastrointestinal atresias. Sepsis screen was positive in 71.4% (50/70). The survival was 45% (9/20) in neonates operated in a single stage and 53.3% (16/30) when operated in 2 stages (P = 0.04). Data analysis of 50 patients revealed that the survived neonates had significantly better birth weight, better gestational age, negative sepsis screen, no cardiac diseases, no pneumonia, and 2-stage surgery (P value 0.002, 0.003, 0.02, 0.02, 0.04, and 0.04, respectively). The day of presentation and abdominal distension had no significant effect (P value 0.06 and 0.06, respectively). This was further supported by stepwise logistic regression analysis. In a limited resources scenario, the survival rate of babies with this association can be improved by treating ARM first and then for EA±TEF in second stage, once mechanical ventilator care became available and sepsis was under control.
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ISSN:0971-9261
1998-3891
DOI:10.4103/0971-9261.98123