MEASUREMENT OF GAP LENGTH IN ESOPHAGEAL ATRESIA - A SIMPLE PREDICTOR OF OUTCOME

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.