Elsevier

Journal of Pediatric Surgery

Volume 38, Issue 12, December 2003, Pages 1726-1729
Journal of Pediatric Surgery

Outcomes in esophageal atresia and tracheoesophageal fistula

Presented at the 36th Annual Meeting of the Pacific Association of Pediatric Surgeons, Sydney, Australia, May 12–16, 2003
https://doi.org/10.1016/j.jpedsurg.2003.08.039Get rights and content

Abstract

Background/Purpose: The purpose of this analysis was to investigate outcomes in newborns with esophageal atresia (EA) or tracheoesophageal fistula (TEF) with respect to prognostic classifications and complications.

Methods: Charts of all 144 infants with EA/TEF treated at British Columbia Children’s Hospital (BCCH) from 1984 to 2000 were reviewed. Patient demographics, frequency of associated anomalies, and details of management and outcomes were examined.

Results: Applying the Waterston prognostic classification to our patient population, survival rate was 100% for class A, 100% for class B, and 80% for class C. The Montreal classification survival rate was 92% for class I and 71% for class II (P = .08). Using the Spitz classification, survival rate was 99% for type I, 84% for type II, and 43% for type III (P < .05). The Bremen classification survival rate was 95% “without complications” and 71% “with complications.” Complications included stricture (52%), gastroesophageal reflux (31%), anastomotic leakage (8%), recurrent fistula (8%), and pneumonia (6%). Seventeen patients underwent fundoplication for gastroesophageal reflux, 16 pre-1992 and one post-1992.

Conclusions: Comparing the major prognostic classifications, the Spitz classification scheme was found to be most applicable. In our institution, the trend in management of gastroesophageal reflux after repair of EA/TEF has moved away from fundoplication toward medical management.

Section snippets

Materials and methods

The hospital records of all infants who were admitted at BCCH, Vancouver, Canada with EA/TEF between 1984 and 2000 were reviewed. Patient demographics, presence of associated anomalies, presence of complications, and details of treatment and outcomes were examined. The major prognostic classification systems for EA/TEF were examined to determine which classification system best predicts survival rates of our patients. The groups in each classification system were compared with the Pearson χ2

Results

Over a period of 16 years (1984 to 2000), 144 infants (87 boys and 57 girls) with EA/TEF were treated at the BCCH. The mean gestational age was 37 weeks (range, 27 to 42 weeks). The average birth weight was 2,485 g (range, 745 to 4,599 g). Types of esophageal anomalies included 13 cases of pure EA (9%), 2 cases of EA with proximal TEF (1%), 119 cases of EA with distal TEF (83%), 2 cases of EA with proximal and distal TEF (1%), and 8 cases of H-type TEF (6%). Associated anomalies occurred in 74

Discussion

Preoperative prognostic classification systems are important for giving clinicians and parents a realistic prognosis for children and to compare results among institutions. In 1962, Waterston et al1 devised one of the first classification systems for EA/TEF. They compared results based on preoperative stratification of cases by severity and expected outcome. Risk factors that Waterston included were low birth weight, pneumonia, and associated congenital anomalies. He concluded that delayed

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    Nowadays the esophageal atresia (EA) repair, if performed in proper pediatric centers, has great results in terms of safety and survivance (even more than 95%, depending on the series)1,2 that leads pediatric surgeons and pediatric gastroenterologists to face late complications related to both the surgical operation and the intrinsic characteristics of the malformation itself; the anastomotic stricture (AS) is certainly one of them. The reported incidence of AS varies from 9%-80% according to the different studies3-10 and can be managed by an endoscopic dilatation program. The worst ASs do not respond to dilations and another surgical procedure is needed to solve them.

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