Analysis of Morbidity and Mortality in 227 Cases of Esophageal Atresia and/or Tracheoesophageal Fistula Over Two Decades

Abstract

Early diagnosis, improved surgical technique, neonatal anesthesia, sophisticated ventilatory support, advanced intensive care management, early treatment of associated anomalies, responsiveness of anastomotic strictures to dilatation, and aggressive treatment of gastroesophageal reflux have influenced survival positively. Improved survival rates were noted irrespective of the traditional Waterston criteria, which now seem outdated. With few exceptions, most infants with esophageal atresia and/or tracheoesophageal fistula should survive in the current era.

Long-term complications of congenital esophageal atresia–single institution experience

“…The incidence of GER in these patients ranges from 35 to 60% [4,5]. Such significant differences are due to different criteria for diagnosis of reflux and time of performing the studies [3].…”

“…However, endoscopy in patients without symptoms of GER is debatable [7,9]. As per literature, 23-64% of children require antireflux operation [4]. 18% of the operated patients, despite fundoplication, require pharmaco-therapy due to progression of histological changes in the esophagus [3].…”

“…With the improvement of surgical technique and advances in the pre-and post-operative care, mortality has decreased among affected children. Children who survive have late complications like gastroesophageal reflux (GER), recurrent respiratory infections, impaired lung ventilation, deformities of the chest and spine [1,2], which can result both from the anatomical defect and from the implemented treatment [3,4].…”

Systematic Review of the Literature: Comparison of Open and Minimal Access Surgery (Thoracoscopic Repair) of Esophageal Atresia with Tracheo-Esophageal Fistula (EA-TEF)

“…Procedures performed, if reported, were Thal or Nissen-fundoplication. Antireflux surgery numbers after open approach was performed in 18 to 32.2% of cases 19,27,28,21,22 . The need for aortopexy in case of a severe tracheomalacia is mentioned in only one paper 11 were it was performed in 6.8% of the cases.…”

Current Controversies in the Surgical Treatment of Esophageal Atresia

“…The implication is that anti-reflux surgery is often necessary in EA + TEf and this has been recognized years ago (48, 88,89). in most cases, surgical creation of a competent anti-reflux valve has rewarding effects in terms of alleviating symptoms but, unfortunately, these effects are transient in a proportion of operated patients ranging from 25 to 40% (90)(91)(92) due to the persistence of the anatomic and physiologic anomalies that account for the GER itself and also to the often imperfect fundoplications achieved in these in-dividuals with open or absent angle of His, small gastric fundus and high-located cardia.…”