Ak. Brown et Pkh. Tam, MEASUREMENT OF GAP LENGTH IN ESOPHAGEAL ATRESIA - A SIMPLE PREDICTOR OF OUTCOME, Journal of the American College of Surgeons, 182(1), 1996, pp. 41-45
BACKGROUND: Previous classifications of esophageal atresia (EA) and tr
acheoesophageal fistula (TEF) have concentrated on associated medical
conditions that influence survival. We propose a classification based
on gap lengths to define the magnitude of the surgical problems in EA
and TEF and correlate them with outcome. STUDY DESIGN: Gaps between th
e esophageal ends were classified as long (greater than 3 cm), interme
diate (greater than 1 cm but less than or equal to 3 cm) or short (les
s than or equal to 1 cm). A series of 66 consecutive patients with EA
and TEF were studied. RESULTS: The outcomes of patients with long (n=1
6), intermediate (n=16), and short (n=34) gaps were respectively: deat
h (18 percent, 6 percent, 3 percent), anastomotic leak (31 percent, 25
percent, 6 percent), stricture (44 percent, 31 percent, 17 percent),
recurrent TEF (6 percent, 6 percent, 6 percent), gastroesophageal refl
ux (56 percent, 37 percent, 36 percent), and failure to thrive (56 per
cent, 43 percent, 18 percent). The mean hospital stay at first admissi
on was (97, 54, 24 days, respectively) and the mean number of readmiss
ions was (6.9, 5.2, 3.4, respectively). CONCLUSIONS: This classificati
on, which is based on easily measurable criteria, provides a useful me
thod to predict morbidity, long-term outcome, and health costs associa
ted with EA. and TEF surgery.