An assessment of quality of life of operated cases of esophageal atresia in the community

Abstract

Aims:To evaluate the outcome of the operated children of esophageal atresia (EA) focusing on their early and late morbidity and mortality and quality of life (QoL) of survivors.Settings and Design:A cross-sectional follow-up with retrospective analysis of available medical and surgical records of children who underwent repair for EA.Materials and Methods:The medical records of the children who underwent repair for EA during the period from 2000 to 2011 at the Christian Medical College Hospital, Vellore, were collected retrospectively. Patients with parents were invited to visit the hospital for follow-up and nutritional status, digestive and respiratory symptoms, status of associated anomalies and QoL assessment of children done. QoL assessment was done using the PedsQL™ 4.0 generic core scales questionnaire comprising 4 scale scores: physical, emotional, social functioning, and school functioning. Mean scores are calculated based on a 5-point response scale for each item and transformed to a 0-100 scale with a higher score representing better QoL.Statistical Analysis Used:Statistical Package for Social Sciences (SPSS) version 16 using Chi-square or Fisher's exact test.Results:Of 79 patients operated during the said period, there were 10 deaths and a total of 69 (87%) children survived. Of the 66 patients available for follow-up, we interviewed 30 parents and children while for the remaining 36 children, out-patients charts were reviewed retrospectively. Mean follow-up duration was 3.56 years. The height and weight for age measurement showed 47% and 56% of children respectively as below the 5th percentile. Main problems faced by operated EA children were of the respiratory (26%) and gastroesophageal (36%) tracts. In spite of the mentioned problems faced, the overall QoL of this group appeared good. In 23 of 30 patients, who answered PedsQL™, more than 70% had scores >85 out of 100 in QoL scoring.Conclusions:While survivals of the children born with EA have improved, these children still face nutritional, respiratory, and gastroesophageal problems during their early childhood. In spite of this, the overall QoL of this patient group appears good.

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.…”

Esophageal Atresia and Tracheoesophageal fistula: Gap Length and Clinical Outcome (A Prospective Study among Group of Iraqi Neonates)

“…The main postoperative complications among the 13 survived neonates included pneumonia, wound infection, anastomotic leak, gastroesophageal reflux and stricture formation were comparable to previous studies (Brown and Tam 1996;Mansur et al, 2005) as these postoperative outcomes are mainly reported in cases with EA with or without TEF. From other point of view, the complications were more frequent with the wider gap, more than 3 cm, these findings supported that reported by Mansur et al, (Mansur et al, 2005) from Egypt and other earlier studies (Bal et al, 2016;Brown and Tam 1996;Livitidis 1973;Puri et al, 1981). The current study suggested that the length of the gap could be a good predictor for the outcome of neonates with EA/TEF, however further studies and further investigations are necessary to explicit the definite predictive role.…”

“…According to our findings females were the dominantly affected with EA/TEF compared to male neonates, while no such difference in survival between both genders, Bal et al, (Bal et al, 2016) found relatively higher incidence among males with a male to female ratio of 41:39, with no significant difference between both genders neither in incidence nor survival, despite the higher incidence in females in our study no significant difference between both genders in survival. Table.3 Gap length of EA/TEF neonates Table.4 Post-operative complications among the 13 survived EA/TEF neonates* *Some cases had more than one complication at the same time Table.5 Distribution of mortality and survival according to the gap length Table.6 Distribution of postoperative complications according to the gap length of survived neonates (N =13)* *Some cases had more than one complication at the same time Associated anomalies and comorbidities were reported in 10/25 (40%) neonates, which is comparable to that reported by Stoll et al, (Stoll et al, 2009) and.…”

“…Table.3 Gap length of EA/TEF neonates Table.4 Post-operative complications among the 13 survived EA/TEF neonates* *Some cases had more than one complication at the same time Table.5 Distribution of mortality and survival according to the gap length Table.6 Distribution of postoperative complications according to the gap length of survived neonates (N =13)* *Some cases had more than one complication at the same time Associated anomalies and comorbidities were reported in 10/25 (40%) neonates, which is comparable to that reported by Stoll et al, (Stoll et al, 2009) and. Bal et al, (Bal et al, 2016). Previous studies refereed that the gap length is a critical factor affecting the outcome, on the other hand the distance between the two ends of esophagus play an important role in the management; for instance the gap length of less than 2 cm could be overcome by local mobilization only (Scott 2014), while the difficulties faced by surgeons in the wider gap, additionally no distinct cut off point for the definition of wide gap and this remain subjected to the opinion of surgeon to be considered as long, ultra long or else (Boyle, Irwin, and Foker 1994;Mansur et al, 2005) However there are different maneuvers recommended to overcome a wide gap such as tubularisation of the upper pouch after creating a flap, circular myotomy of the upper pouch or abandoning any attempt at initial primary anastomosis awaiting delayed primary anastomosis 6-12 weeks later (Gough 1980;Livitidis 1973;Puri et al, 1981;Spitz 2007).…”

Health-Related Quality of Life in Patients after Repair of Esophageal Atresia: A Review of Current Literature

“…described HRQoL among children and adolescents born with EA, [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] three of which 32,34,38 also reported on HRQoL among adults (patients >18 years old). The remaining two articles described HRQoL among adults with EA only.…”