Esophageal atresia and tracheoesophageal fistula: surgical experience over two decades
| Autor: | S. Frank Redo, Nitsana Spigland, Josephine Y Tsai, Leah Berkery, David E. Wesson |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male Reoperation medicine.medical_specialty Colon Fistula Tracheoesophageal fistula Gestational Age Anastomosis Necrosis Esophagus Recurrence Cause of Death medicine Birth Weight Humans Esophageal Atresia Retrospective Studies Esophageal disease business.industry Respiratory disease Anastomosis Surgical Infant Newborn Gestational age medicine.disease Dilatation Surgery Survival Rate medicine.anatomical_structure Atresia Esophageal Stenosis Female Cardiology and Cardiovascular Medicine business Tracheal Stenosis Follow-Up Studies Tracheoesophageal Fistula |
| Zdroj: | The Annals of thoracic surgery. 64(3) |
| ISSN: | 0003-4975 |
| Popis: | Background . Despite improvements in survival, for infants born with esophageal atresia tracheoesophageal fistula, or both, the morbidity associated with repair of these anomalies remains high. Methods . This report retrospectively analyzes 81 patients with esophageal atresia, tracheoesophageal fistula, or both presenting to our institution between 1975 and 1995, with a focus on anastomotic complications. Results . There were 46 male and 35 female patients with a mean gestational age of 37 weeks and mean birth weight of 2443 g. Forty-four patients underwent primary esophageal anastomoses, 7 underwent delayed primary anastomoses, 12 patients underwent staged repairs, and 5 underwent repair of H-type fistulas. Among 62 patients with anastomoses, complications included stricture in 25/62 patients (40%), leakage in 12/62 patients (19%), and recurrent tracheoesophageal fistulas in 6/62 patients (10%). Stricture rates for esophagocolonic anastomoses versus esophagoesophageal anastomoses were 4/8 cases (50%) versus 21/54 cases (39%). This difference was not statistically significant. All esophagoesophageal strictures were managed successfully with dilations; three of four esophagocolonic strictures required anastomotic revision. The leakage rate for esophagocolonic anastomoses versus esophagoesophageal anastomoses was 6/8 cases (75%) versus 6/54 cases (11%). This difference was statistically significant ( p = 0.0003). Two patients required revision of their colon grafts secondary to necrosis. Eighteen of 81 patients (22%) died. Operative mortality was 9/74 (12%). Causes of death included associated anomalies (n = 15), recurrent aspiration and sepsis secondary to missed fistula (n = 1), and unknown (n = 2). Conclusions . Although the morbidity associated with surgical repair of these anomalies is high, this does not affect the overall survival. The high complication rate associated with colonic interposition suggests that one should preserve the native esophagus as a primary conduit whenever feasible. |
| Databáze: | OpenAIRE |
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