Prognosis of congenital tracheoesophageal fistula with esophageal atresia on the basis of gap length

Abstract

Congenital tracheoesophageal fistula (TEF) with esophageal atresia (EA) is not an uncommon disease of newborns. Several classifications have been advocated for predicting the outcomes of these patients but all are physiological and concentrated on associated medical condition that influences survival. We emphasize a new classification on the basis of gap between two esophageal pouches to define the magnitude of surgical problems in the primary repair and correlate them with the outcomes in terms of anastomotic leak, esophageal stricture and mortality, keeping other prognostic factors constant. A total of 50 cases of congenital TEF with EA were included and all underwent primary esophageal anastomosis after the ligation of TEF. The gap between the two pouches was meticulously measured intraoperatively using a vernier caliper before the ligation of TEF, and patients were divided into four groups on the basis of gap length. Group A, where gap length was >3.5 cm (ultralong), group B where gap length was 2.1-3.5 cm (long gap), group C where gap length was >1 cm but not more than 2 cm (intermediate group) and group D, where the gap between two esophageal pouches was 1 cm or less (short gap). The incidence of anastomotic leak was 80, 50, 28, 10.5% and the incidence of esophageal stricture was 100, 75, 22.5, 19% after successful primary repair, respectively, in groups A, B, C and D. The mortality was highest in group A (80%) followed by group B (50%) and 22% in group C and least 15.6% in group D. The incidences of esophageal leak and mortality were found to be statistically significant. This classification which is based on easily measurable criteria provides a useful method to predict morbidity, long-term outcome and mortality of EA with TEF surgery.

Esophageal stenting in children: indications, application, effectiveness, and complications

“…3,6,7 Approximately 25% of infants with esophageal atresia will develop postanastomotic fibrotic strictures, and the incidence of such strictures has been shown to increase with increasing esophageal gap length. 22,23 At the University of Minnesota, we serve as a referral base for the management of long-gap esophageal atresia and patients previously treated for strictures or fistula leaks. Our technique, developed during a decade of experience, is to dilate early and vigorously after primary repair to cause the stricturing tendency to relent and prevent dense scar formation.…”

Esophageal Atresia with Tracheo-Esophageal Fistula Presenting Beyond 7 Days

“…However, none of our patients had anastomotic leak in postoperative period. Studies have shown that apart from associated comorbidities and congenital anomalies, the complications and mortality is an outcome of gap length [14,15]. The long gap is associated with high The mortality in the Group B was 60%.…”

One Stage Reconstruction of Esophageal Atresia and Distal Tracheoesophageal Fistula in a 3250-gm Neonate: A Case Report

“…The suture material, type of anastomosis, anastomotic tension, ischemia, anastomotic leak and the presence of GER are the main factors affecting the development of anastomotic strictures [4]- [7]. The technique intraoperation and the way of anastomosis are very important for post-operative complications preventing.…”