Experience in patients with esophageal atresia and tracheoesophageal fistula
Hakan Taşkınlar1, İsa Kıllı1, Yalçın Çelik2, Dinçer Avlan1, Ali Naycı1
1Mersin Üniversitesi, Tıp Fakültesi, Çocuk Cerrahisi Anabilim Dalı, Mersin
2Mersin Üniversitesi, Tıp Fakültesi,Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Neonataloji Bilim Dalı, Mersin
Keywords: esophageal atresia, tracheoesopheageal fistula, surgical management
Abstract
Objective: The surgical management and results of patients who have been operated for esophageal atresia and tracheoesophageal fistula in our department were evaluated.
Material and Methods: This study included 47 patients’ medical records that were treated for esophageal atresia with tracheoesophageal atresia at our institution between January 2000 and January 2012. Gestational age, birth weight, gender, type of atresia, associated anomalies, risk classification, complications, and the surgical management of high risk patients was retrospectively analyzed.
Results: 47 patient (28 female and 19 male) with a median gestational age 36 weeks (29-40) and median birth weight 2400 grams (925-3760) were included in this study. 34 patients (72.3 %) had associated anomalies and 30 (63,8 %) of them were cardiovascular anomalies. 6 patients (12.7 %) had additional surgical gastrointestinal pathologies (anal and duodenal atresia). 36 had primary anastomosis in an early period but 4 patients with severe pneumonia, low birth weight and congenital anomalies were operated in a late period after the general condition stabilized. 6 patients (5 isolated EA and 1 long gap EA) had esophagostomy and gastrostomy. 2 colon interpositions were performed for isolated EA. 26 patients (55,3 %) had anastomotic strictures which resolved with balloon dilatations. Mean balloon dilatation number was 5.1 (1-13). Anastomotic leakage was seen in 3 (6,3 %) patients and all recovered with conservative treatment. Gastroesophageal reflux was seen in 13 (55,3 %) patients. 1 (2,1 %) patient had recurrent fistula. 4 patients with severe tracheomalacia and respiratory distress underwent aortopexy surgery. Overall mortality rate was 6.7 %.
Conclusion: In our clinical series, anastomotic stricture rate was high and the overall mortality rate was low. Diagnosis and treatment of gastroesophageal reflux in an early period can help to decrease the anastomotic stricture rate. Primary anastomosis should be attempted for esophageal atresia and tracheoesophageal fistula. Delaying thoracic surgery until the stabilization of patients with severe pneumonia, associated heart defects and anomalies will decrease the mortality rates.