Predictive factors for complications in children with esophageal atresia and tracheoesophageal fistula

Abstract

The objective of this study was to describe the incidence of complications in children with esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) at a tertiary pediatric hospital and to identify predictive factors for their occurrence. A retrospective chart review of 110 patients born in or transferred to Sydney Children's Hospital with EA/TEF between January 1999 and December 2010 was done. Univariate and multivariate regression analyses were performed to identify predictive factors for the occurrence of complications in these children. From univariate analysis, early esophageal stricture formation was more likely in children with 'long-gap' EA (odds ratio [OR] = 16.32). Patients with early strictures were more likely to develop chest infections (OR = 3.33). Patients with severe tracheomalacia were more likely to experience 'cyanotic/dying' (OR = 180) and undergo aortopexy (OR = 549). Patients who had gastroesophageal reflux disease were significantly more likely to require fundoplication (OR = 10.83) and undergo aortopexy (OR = 6.417). From multivariate analysis, 'long-gap' EA was a significant predictive factor for late esophageal stricture formation (P = 0.007) and for gastrostomy insertion (P = 0.001). Reflux was a significant predictive factor for requiring fundoplication (P = 0.007) and gastrostomy (P = 0.002). Gastrostomy insertion (P = 0.000) was a significant predictive factor for undergoing fundoplication. Having a prior fundoplication (P = 0.001) was a significant predictive factor for undergoing a subsequent aortopexy. Predictive factors for the occurrence of complications post EA/TEF repair were identified in this large single centre pediatric study.

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

“…[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. 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.…”

“…Early recognition and treatment of potential complications is therefore essential in order to prevent poor long-term results. [19][20][21][22] At present, there is limited published data from large series of EA/TEF patients following surgery with regard to adverse events and their influence on functional outcome later in life. 24 Thus, the aim of this longitudinal study was to assess temporal changes in morbidity and mortality of patients with EA/TEF treated in a tertiary-level center, focusing on postoperative complications and their impact on long-term gastroesophageal function.…”

A prospective study in esophageal atresia with tracheoesophageal fistula: Oblique versus circular anastomosis

“…Multiple risk factors are identified for Anastomotic stricture, such as long-gap EA with consequent anastomotic tension, postoperative anastomotic leak, gastro-esophageal reflux disease (GERD), general condition of the patient, the nature of suture material used, and type of anastomosis performed. [8][9][10] There are various anastomotic methods described to avoid or minimized this complication. The First anastomotic technique to prevent post-operative stricture given by Sulamaa et al in 1951.…”

Eosinophilic esophagitis and esophageal atresia: coincidence or causality?

“…It is secondary to esophageal dysmotility, short esophagus, lower esophageal sphincter pressure, and chronic lung disease. 4,17,18 Dysmotility is the result of intrinsic factors related to abnormal esophagus development or partial denervation during surgery. Motor patterns were described in a cohort of children with EA using a high resolution manometry.…”