ANALYSIS OF MORBIDITY AND MORTALITY IN 227 CASES OF ESOPHAGEAL ATRESIA AND OR TRACHEOESOPHAGEAL FISTULA OVER 2 DECADES/

Objective: This report analyzes the morbidity and mortality in 227 inf ants (127 boys and 100 girls) with variants of esophageal atresia and/ or tracheoesophageal fistula who were treated from 1971 to 1993. Desig n: Data were collected retrospectively from hospital and office record s. Mean follow-up was 76 months, ranging from 1 month to 22 years. Set ting: Patients were treated at a tertiary care children's hospital. Re sults: The mean birth weight was 2557 g (range, 1100 to 4460 g), and t he mean gestational age was 38 weeks (range, 28 to 42 weeks). Classifi cation included 29 cases of type A esophageal atresia (13%); two cases of type B (1%), 178 cases of type C (78%), five cases of type D (2%), and 13 cases of type E (6%). Associated anomalies occurred in 146 inf ants (64%), including cardiac defects in 86 (38%), skeletal defects in 44 (19%), neurological defects in 34 (15%), renal defects in 35 (15%) , anorectal defects in 18 (8%), and other abnormalities in 30 (13%). A single-layer anastomosis was performed in 81%, and a two-layer repair , in 17%. Esophagomyotomy was necessary in 9% of the patients. Anastom otic complications included leakage (16%), symptomatic stricture (35%) , and recurrent tracheoesophageal fistula (3%). Gastroesophageal reflu x was present in 127 cases (58%), with 56 (44%) requiring an antireflu x procedure. Tracheomalacia occurred in 32 cases (15%), and 13 require d operative treatment. Postoperative esophageal dysmotility was docume nted in 56 children (30%). The overall survival rate was 95%. The caus e of death in 12 patients included severe cardiac anomalies (n=3), fat al sleep apnea (n=1), renal failure (n=1), trisomy 18 (n=2), accidenta l decannulation of tracheostomy (n=1), pulmonary failure (n=1), and un known causes (n=3). Conclusions: Early diagnosis, improved surgical te chnique, neonatal anesthesia, sophisticated ventilatory support, advan ced intensive care management, early treatment of associated anomalies , responsiveness of anastomotic strictures to dilatation, and aggressi ve treatment of gastroesophageal reflux have influenced survival posit ively. Improved survival rates were noted irrespective of the traditio nal Waterston criteria, which now seem outdated. With few exceptions, most infants with esophageal atresia and/or tracheoesophageal fistula should survive in the current era.