| Abstrakt: |
Patients treated for esophageal atresia during 1984 and 1985 were evaluated prospectively to ensure early detection and treatment of gastroesophageal reflux, in an attempt to reduce postoperative morbidity. A previous, retrospective study had indicated that spontaneous reflux was the major cause of morbidity, leading to esophagitis and stenosis. Surgery consisted of an end-to-end anastomosis for all 19 patients. Postoperatively, an antacid was administered at the first sign of reflux with domperidone as adjuvant therapy on roentgenographic evidence of esophagitis. Stenosis was treated with esophageal dilation. Regular, 6-weekly examinations included an esophagram and, on indication, esophagoscopy. Of 12 patients with reflux, 9 developed stenosis and 7 had esophagitis. Six patients with persistent reflux underwent Nissen fundoplication; 5 of them suffered from esophagitis, in 4 cases associated with stenosis, while the 6th patient had life-threatening cyanotic spells. At 6 months of age all 19 patients were asymptomatic, although 2 had mild dysphagia secondary to a motility disorder of the esophagus. While early detection and conservative treatment of reflux did not reduce the frequency of stenosis or esophagitis, it did reduce the morbidity rate and duration of hospitalization, because effective treatment of stenosis and esophagitis could be initiated at an early stage. |
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