ESOPHAGEAL ATRESIA IN OSAKA - A REVIEW OF 39 YEARS EXPERIENCE

Background: One hundred fifty-nine patients who had eso phageal atresi a with or with out tracheoesophageal fistula have been treated at Osak a University Medical School and its affiliated hospitals since the ini tial (Japanese) experience of Dr T. Ueda in 1957. Methods: These cases were divided chronologically into three groups, With earlier recognit ion of surgical neonates and the development of perinatal care, the lo ng-term survival of these patients has steadily improved over 39 years from 28% in the first period (1957 to 1967) to 80% in the third perio d (1980 to 1995). Of 141 patients treated in the second and third peri ods (1968 to 1995), 92 (65.2%) had associated anomalies. Cardiovascula r and gastrointestinal malformations were the most frequently seen maj or anomalies. VATER or VACTER association was seen in 12.8% (18 of 141 ) of these patients. Survival of these cases according to Waterston ri sk factors was 100% for group A, 100% for group B, and 50% for group C , whereas the new classification proposed by Spitz showed survival of 92% for group 1, 50% for group 2, and 0% for group 3, showing better d ifferentiation among the three groups. Results: There was a long gap b etween the proximal and distal esophageal ends in seven patients (type A), in all of whom primary anastomosis was possible after 28 to 128 d ays of elongation by bouginage. Although the survival of esophageal at resia patients dramatically improved in recent years, there is still a high incidence of early and long-term postoperative complications, ie , anastomotic leakage (26.5%), recurrent fistula (7.2%), anastomotic s truture (49.1%), postoperative pneumonia or atelectasis (57.0%), trach eomalacia (25.8%), and gastroesophageal reflux (52.0%). Conclusions: R ecently, there have been changing patterns in the occurrence of compli cations, which are mainly attributed to technical improvement, better perinatal care and early recognition of pathophysiologic conditions su ch as tracheomalacia and gastroesophageal reflux. Copyright (C) 1997 b y W.B. Saunders Company.