Determinants of gap length in esophageal atresia with tracheoesophageal fistula and the impact of gap length on outcome

Abstract

Aim:This study was aimed at identifying factors which may affect the gap length in cases of esophageal atresia with tracheoesophageal fistula (EA-TEF) and whether gap length plays any role in determining the outcome.Materials and Methods:All consecutive cases of EA-TEF were included and different patient parameters were recorded. Plain radiographs with a nasogastric tube in the upper esophagus were taken. Patients were grouped into T1-T2; T2-T3; T3-T4; and T4 depending on the thoracic vertebral level of the arrest of the tube. During surgery, the gap length between the pouches was measured using a Vernier caliper and the patients were grouped into A, B, and C (gap length >2.1 cm; >1-≤2 cm and ≤1 cm). The operative gap groups were compared with the radiography groups and the other recorded parameters.Results:Total numbers of cases were 69. Birth weight was found to be significantly lower in Group A (mean = 2.14 kg) as compared to Group B (mean = 2.38 kg) and Group C patients (mean = 2.49 kg) (P = 0.016). The radiographic groups compared favorably with the intraoperative gap length groups (P < 0.001). The need for postoperative ventilation (70.83% in Group A vs. 36.84% in Group C, P = 0.032) and mortality (62.5%, 26.9% and 15.8% in Group A, B, and C, respectively, P = 0.003) co-related significantly with the gap length.Conclusion:Birth weight had a direct reciprocal relationship with the gap length. Radiographic assessment correlated with intraoperative gap length. Higher gap length was associated with increased need for postoperative ventilation and poor outcome.

Prediction of gap length by plain radiograph of chest with nasogastric tube in the upper esophagus in patients with esophageal atresia and distal tracheoesophageal fistula

“…Similar results were indicated in an earlier preliminary study by the authors while studying factors affecting the gap length and its effect on the final outcome of the patients. [10] Factors such as birth weight gestational age, age at presentation, associated anomalies and postoperative outcome have earlier been studied by authors. Birth weight had direct reciprocal relationship with the gap length.…”

“…Higher gap length was also associated with increased need for postoperative ventilation and poor outcome. [10]…”

Magnetic Resonance Imaging-Based Evaluation of Anatomy and Outcome Prediction in Infants with Esophageal Atresia

“…This information suggests the presence of a TED but provides very limited information regarding the specific anatomy of an EA/TEF, its effect on the infants' airway, and the gap length between the proximal and distal esophageal pouches. These anatomic details significantly impact the clinical course of infants with TEDs [4][5][6][7][8][9].…”

Retrospective analysis of neurological findings in esophageal atresia: Allostatic load of disease complexity, cumulative sedation, and anesthesia exposure

“…Traditionally, EA has been classified into types A‐D according to anatomical characteristics in relation to airway structures (Gross, 1962). In addition, EA can also be described and categorized by the length of esophageal gap into short‐gap and long‐gap EA, which reflects the complexity of underlying disease and perioperative critical care (Rassiwala et al, 2016). Specifically, infants born with short‐gap EA undergo repair by primary anastomosis, requiring only one major surgery (Hunt et al, 2016) and shorter postoperative sedation and pain management course.…”