Results from the French National Esophageal Atresia register: one-year outcome

Abstract

BackgroundThe aim of the present national prospective population-based study was to assess the early morbidity of esophageal atresia (EA).MethodsAll 38 multidisciplinary French centers that care for patients with EA returned a specific questionnaire about the 1-year outcome for each patient. This information was centralized, checked, and entered into a database.ResultsFrom the total population of 307 EA patients born in 2008 and 2009, data about the 1-year outcome were obtained from 301 (98%) patients, of whom 4% were lost to follow-up and 5% died. Medical complications occurred in 34% of the patients: anastomotic leaks (8%), recurrent tracheoesophageal fistula (4%), and anastomotic stenosis (22%); all of the latter group needed dilation (median, 2 dilations/patient). A new hospitalization was required for 59% of patients (2.5 hospitalizations/patient) for digestive (52%) or respiratory (48%) reasons. Twelve percent of patients required antireflux surgery at a median age of 164 days (range, 33–398 days), and 1% underwent an aortopexy for severe tracheomalacia. The weight/age Z-score was −0.8 (range, −5.5 to 3.7 months) at 12 months. Fifteen percent of patients were undernourished at 12 months of age, whereas 37% presented with respiratory symptoms and 15% had dysphagia at the last follow-up. Significant independent factors associated with medical complications were anastomotic esophageal tension (p = .0009) and presence of a gastrostomy (p = .0002); exclusive oral feeding at discharge was associated with a decreased risk of complications (p = .007).ConclusionsDigestive and respiratory morbidities remain frequent during the first year of life and are associated with difficult anastomosis and lack of full oral feeding.Electronic supplementary materialThe online version of this article (doi:10.1186/s13023-014-0206-5) contains supplementary material, which is available to authorized users.

Postoperative Complications and Functional Outcome after Esophageal Atresia Repair: Results from Longitudinal Single-Center Follow-Up

“…8 Because of its rarity and complex nature, EA/TEF represents one of the major therapeutic challenges not only in modern pediatric surgery but also for other specialties involved due to serious short-and long-term morbidities. [13][14][15][16][17][18] Our results were consistent with previous studies indicating that despite precise esophageal reconstruction and excellent postoperative care, early and late complications frequently occur and must be dealt with. [19][20][21][22] The definition of possible complications is however lacking standardization, which makes an exact comparison with the literature difficult and thus results in highly variable incidence rates.…”

“…[19][20][21][22] The definition of possible complications is however lacking standardization, which makes an exact comparison with the literature difficult and thus results in highly variable incidence rates. 13,14 It can be assumed that the development of complications after initial EA/TEF repair is most likely a multifactorial process that depends on applied surgical techniques, peri-/postoperative care, and individual patient factors. 29 Early complications in our cohort included minor (6.3%) or major (5.2%) anastomotic leaks, recurrent TEF with (1.0%) or without (9.4%) anastomotic stricture, initially missed proximal fistula (4.2%) and refractory anastomotic strictures with (1.0%) or without (2.1%) fistula.…”

“…9,10 Today, improved survival of newborns with EA/TEF is likely related to multiple factors including advances in neonatal intensive care and anesthesia, refined surgical techniques, parenteral nutrition, and antibiotics. 11,12 However, early [13][14][15] and late [16][17][18] postoperative morbidities frequently occur after initial repair of EA/TEF despite excellent surgical and neonatal management, and can be associated with impaired outcomes. Early recognition and treatment of potential complications is therefore essential in order to prevent poor long-term results.…”

Impact of Surgery for Neonatal Gastrointestinal Diseases on Weight and Fat Mass

“…1,3 Surgical necrotizing enterocolitis (NEC) increases the risk of poor growth at 18-22 months of age with respect to medical NEC. 2 Nutritional problems in neonates requiring gastrointestinal surgery are not unusual and nutritional support in these infants is often challenging.…”

Surgical congenital anomalies in Albania: incidence, prenatal diagnosis and outcome

“…There were no changes in incidence, but with high mortality in total compared with developed countries (despite 100% survival during the last year) 17 21–23. The survival rate of esophageal atresia in developed countries has reached a plateau since 1980 and seems to be currently stable at around 95% 24. Pedersen et al 17 reported survival from 86.9% to 99.2% for esophageal atresia from 23 European countries in 1987–2006.…”