Experience in treating congenital esophageal atresia in China

• Published in: Journal of pediatric surgery Vol. 45; no. 10; pp. 2009 - 2014
• Main Authors: Zhang, Zhibo, Huang, Ying, Su, Pengjun, Wang, Dajia, Wang, Lianying
• Format: Journal Article
• Language: English
• Published: United States 01.10.2010
• Subjects: Abnormalities, Multiple - diagnosis; Abnormalities, Multiple - surgery; Cause of Death; China; Esophageal Atresia - diagnosis; Esophageal Atresia - surgery; Female; Gastroesophageal Reflux - diagnosis; Gastroesophageal Reflux - etiology; Humans; Infant; Infant, Newborn; Male; Pneumonia - mortality; Postoperative Complications - diagnosis; Postoperative Complications - mortality; Preoperative Care; Prognosis; Survival Rate; Tomography, X-Ray Computed; Tracheoesophageal Fistula - diagnosis; Tracheoesophageal Fistula - surgery; Treatment Outcome; China
• ISSN: 1531-5037
• DOI: 10.1016/j.jpedsurg.2010.05.017

The aim of the study was to evaluate our recent experience in treating esophageal atresia (EA) and the outcomes observed at a single center for pediatric surgery. The records of infants with EA from 2006 to 2009 were reviewed. Birth weight, associated anomalies, details of management, complications, and outcomes were examined. Forty-eight consecutive infants with EA were identified from 2006 to 2009, of which 33 (69%) were boys. Mean birth weight was 2668 g (range, 1700-3800 g). Common associated malformations (35%) were cardiac anomalies, imperforate anus, limb anomalies, and chromosomal anomalies. Forty-seven were Gross type C, and one was Gross type A. Forty-five infants underwent ligation of the tracheoesophageal fistula and end-to-side primary anastomosis, and one received a colonic interposition. Six patients died (12.5% mortality). Three died before or during operation because of severe pneumonia and complex cardiac anomalies, and 3 died during recovery (within 1 month after repair) because of aspiration and severe pneumonia (early postoperative mortality was 6.67%). Complications included pneumonia, anastomotic leakage (16%, all recovered after conservative treatment), wound sepsis (11%), recurrent tracheoesophageal fistula (9%) (3/4 recovered after conservative treatment), anastomotic stricture (10%), and gastroesophageal reflux in about 2 of 3 patients. Preoperative computed tomographic imaging and 3-dimensional graphic reconstruction used in 15 patients were useful. Most patients with EA have excellent short- to midterm surgical outcomes. The main factors for mortality are complex cardiac anomalies, aspiration, and pneumonia. Computed tomographic imaging and 3-dimensional graphic reconstruction can provide surgeons with excellent preoperative reference about the anatomy of the defect. Most anastomotic related complications resolve with conservative treatment. Patients of low-risk prognosis group with type A and long gap EA can be managed with a primary colonic interposition with good results. The main midterm complications are gastroesophageal reflux and stricture.