An 18-year experience of tracheoesophageal fistula and esophageal atresia

Abstract

PurposeTo determine the clinical manifestations and outcomes of patients with tracheoesophageal fistula (TEF) and esophageal atresia (EA) born at a single neonatal intensive care unit.MethodsA retrospective analysis was conducted for 97 patients with confirmed TEF and EA who were admitted to the neonatal intensive care unit between 1990 and 2007.ResultsThe rate of prenatal diagnosis was 12%. The average gestational age and birth weight were 37+2 weeks and 2.5±0.7 kg, respectively. Thirty-one infants were born prematurely (32%). Type C was the most common. The mean gap between the proximal and distal esophagus was 2 cm. Esophago-esophagostomy was performed in 72 patients at a mean age of 4 days after birth; gastrostomy or duodenostomy were performed in 8 patients. Forty patients exhibited vertebral, anorectal, cardiac, tracheoesophageal, renal, limb (VACTERL) association with at least 2 combined anomalies, and cardiac anomaly was the most common. The most common post-operative complications were esophageal stricture followed by gastroesophageal reflux. Balloon dilatation was performed for 1.3 times in 26 patients at a mean age of 3 months. The mortality and morbidity rates were 24% and 67%, respectively, and the most common cause of death was sepsis. The weight of approximately 40% patients was below the 10th percentile at 2 years of age.ConclusionMortality and morbidity rates of patients with TEF and EA are high as compared to those of infants with other neonatal surgical diseases. Further efforts must be taken to reduce mortality and morbidity and improve growth retardation.

Developmental Status of Children Operated for Esophageal Atresia with or without Tracheoesophageal Fistula Along with Maternal Stress, Their Quality of life, and Coping Abilities at AIIMS, New Delhi

“…The EA with or without TEF is the common congenital anomaly found in isolation or in combination with other associated anomalies in neonates that affect them later in their childhood even after the definite repair. These children tend to have ongoing illnesses due to numerous complications which contribute to higher incidence of impaired physical functioning as reported by Leibovitch et al, 4 Menzies et al, 5 Bal et al, 22 Lacher et al, 23 and Seo et al 24 Similar results were observed in the present study as almost half of children had low weight and height for age. Surgery done in the neonatal period under general anesthesia, prolonged ventilation, and development of early and late complications in childhood requiring repeated hospitalization is considered to be the contributing factors for delayed neurodevelopment among these children.…”

Demographic characteristics in patients with short-gap and long-gap esophageal atresia

“…In a recent cohort comprising 307 new esophageal cases, polyhydramnios was present in 53.5% of the cases [18]. The 17.2% rate of polyhydramnios in the present study was lower than those reported previously [11,[14][15][16]. This may be explained by the relatively low number of prenatally diagnosed cases included in our series than have been included in previously published series.…”

Associated congenital anomalies between neonates with short-gap and long-gap esophageal atresia: a comparative study

“…Defects of the VACTERL spectrum covered vertebral anomalies (including costal anomalies), anorectal malformations, cardiovascular malformations, TEF (distal and/or proximal), renal anomalies, or radial-type limb anomalies 14. Diagnosis of the VACTERL association was defined as the presence of EA and at least two combined defects of the VACTERL spectrum including vertebral, anorectal, cardiovascular, and renal- or radial-type limb anomalies 15. Moreover, the non-VACTERL-type defect was defined if any of these anomalies was present: hydrocephalus, orofacial defects (cleft lip/palate, supernumerary nostril, and tongue-tie), respiratory system anomalies (choanal atresia, laryngeal anomalies, lung hypoplasia, and diaphragmatic hernia), gastrointestinal anomalies (duodenal atresia, intestinal malrotation, hypertrophic pyloric stenosis, and annular pancreas), genital anomalies (undescended testis, hypospadias, and ambiguous genitalia), and non-VACTERL limb defects, eg, lower limb anomalies 14.…”