ANTERIOR FLAP REPAIR OF ESOPHAGEAL ATRESIA - A 16-YEAR EVALUATION

The aim of the study was to evaluate the outcome of primary repair of oesophageal atresia (OA)/tracheo-oesophageal (TOF) using an anterior f lap from the upper pouch to relieve tension on the anastomosis. Of 66 patients with OA/TOF managed in this institution in the period 1977-19 93, only 1 (1.5%) had a colonic interposition. There were 15 (10 long- gap OA) primary repairs with an anterior flap. Median follow-up was 2 years (range 11 months-16 years). Complications included anastomotic l eaks in 4 (27%), anastomotic strictures in 13 (87%): of which 2 (13.3% ) required resection, gastro-oesophageal reflux in 9 (60%), of which 3 (20%) required fundoplication, recurrent TOF in 2 (14%), and oesophag eal incoordination in 6 (40%). Median hospital stay was 77 days (range 18-240 days). There were 3 late deaths (12, 12, 14 months). Of 12 sur vivors, 8 (66.7%) achieved normal growth. In addition, 3 patients had a myotomy as well as a flap (anastomotic leak 2, stricture 3). We conc lude that the anterior flap technique for repair of OA/TOF reduces the need for oesophageal replacement, There is considerable morbidity ass ociated with its use in these high-risk patients, but a satisfactory o utcome can be achieved in long-term survivors.