Esophageal atresia with or without tracheoesophageal fistula: success and failure in 94 cases

Abstract

BACKGROUNDThe management of newborns with esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) has evolved considerably over the years. Currently an overall survival of 85% to 90% has been reported from developed countries. In developing countries, several factors contribute to higher mortality rates. We describe our experience with 94 consecutive cases of EA with or without TEF.PATIENTS AND METHODSWe retrospectively studied 94 patients with EA with or without TEF treated at our hospital over a period of 15 years. Medical records were reviewed for age at diagnosis, sex, birth weight, associated anomalies, aspiration pneumonia, method of diagnosis, treatment, postoperative complications and outcome.RESULTSNinety-four newborns (55 males and 39 females) with EA/TEF were treated at our hospital. Their mean birth weight was 2.2 kg (700 g to 3800 g). Age at diagnosis ranged from birth to 7 days. At the time of admission 37 (39.4%) had aspiration pneumonia. Associated anomalies were seen in 46 (49%) patients. Thirteen patients had major associated anomalies that contributed to mortality. Postoperative complications were similar to those from developed countries but overall operative mortality (30.8%) was high.CONCLUSIONSThe overall mortality was high but excluding major congenital malformations, sepsis was the most frequent cause of death. Factors contributing to mortality included prematurity, delay in diagnosis with an increased incidence of aspiration pneumonia and a shortage of qualified nurses. To improve overall outcome, factors contributing to sepsis should be evaluated and efforts should be made to overcome them.

State of Play: Eight Decades of Surgery for Esophageal Atresia

“…This is due to the fact that we also included studies with very-lowbirth-weight infants and articles from third world countries in this report. 27,[31][32][33][34] However, it has been suggested that birth weight is nowadays not an important factor as it was previously, although major cardiac anomalies are still of poor prognostic aspect. 35 In our report, leakage rate remained stable over time between 11 and 16%, suggesting that surgical variations do not have any substantial influence on this complication.…”

Prise en charge péri-opératoire de l’atrésie de l’œsophage: petits pas non négligeables à Madagascar

“…Leur admission médiane de 3 [1–9] jours après la naissance, était directe. La mortalité globale était de 76,5%.…”

Oesophageal Atresia: Drowning a Child in His/Her Own Saliva

“…The common associated anomalies in non-syndromic oesophageal atresia include the cardiovascular system (CVS), genitourinary tract (GUT), gastrointestinal tract (GIT), musculoskeletal system (MSS), and central nervous system (CNS) ( Table 4). Cardiovascular anomalies tend to occur most frequently (Table 4) [23,25,27]. This is followed by the GUT, GIT, MSS, and CNS (neurologic anomalies).…”

“…Disconnection of distal TOF is done at most centres through thoracotomy. At our centre, however, this is done by dividing the abdominal oesophagus during the placement of the feeding gastrostomy [27]. This helps to avoid the stress of thoracotomy that may negatively affect patient outcome.…”