Outcome and management in infants with esophageal atresia – A single centre observational study

• Published in: Journal of pediatric surgery Vol. 51; no. 9; pp. 1421 - 1425
• Main Authors: Donoso, Felipe, Kassa, Ann-Marie, Gustafson, Elisabet, Meurling, Staffan, Lilja, Helene Engstrand
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2016
• Subjects: Anastomotic Leak - epidemiology; Esophageal atresia; Esophageal Atresia - mortality; Esophageal Atresia - surgery; Esophagoplasty; Female; Follow-Up Studies; Humans; Incidence; Infant; Infant, Newborn; Male; Morbidity; Outcome; Pediatrics; Retrospective Studies; Surgery; Tracheoesophageal fistula; Treatment Outcome; Esophageal atresia; Tracheoesophageal fistula; Outcome; Morbidity
• ISSN: 0022-3468; 1531-5037; 1531-5037
• DOI: 10.1016/j.jpedsurg.2016.03.010

Abstract Background/Purpose A successful outcome in the repair of esophageal atresia (EA) is associated with a high quality pediatric surgical centre, however there are several controversies regarding the optimal management. The aim of this study was to investigate the outcome and management EA in a single pediatric surgical centre. Methods Medical records of infants with repaired EA from 1994 to 2013 were reviewed. Results 129 infants were included. Median follow-up was 5.3 (range 0.1–21) years. Overall survival was 94.6%, incidences of anastomotic leakage 7.0%, recurrent fistula 4.6% and anastomotic stricture 53.5% (36.2% within first year). In long gap EA (n = 13), delayed primary anastomosis was performed in 9 (69.2%), gastric tube in 3 (23.1%) and gastric transposition in one (7.7%) infants. The incidences of anastomotic leakage and stricture in long gap EA were, 23.1% and 69.2%, respectively. Peroperative tracheobronchoscopy and postoperative esophagography were implemented as a routine during the study-period, but chest drains were routinely abandoned. Conclusion The outcome in this study is fully comparable with recent international reports showing a low mortality but a significant morbidity, especially considering anastomotic strictures and LGEA. Multicenter EA registry with long-term follow up may help to establish best management of EA.