PURE ESOPHAGEAL ATRESIA - A 50-YEAR REVIEW

This review encompasses 50 years (1942 through 1991) and 69 newborns ( 43 boys, 26 girls). Half the babies were premature (weighing less than 2.5 kg). and about one third had other anomalies. The procedures used in this series were late primary anastomosis (17), gastric tube recon struction (16), staging esophagostomy and gastrostomy (13), gastric pu ll up (13), early primary anastomosis (4), and colon replacement (3). Four neonates received no treatment. The most common repair in the 194 0s and 1950s was the gastric pull-up; the gastric tube was the most po pular in the 1960s and 1970s. Delayed primary anastomosis has been the operation of choice since the 1980s. Over the last decade, it has bec ome apparent that primary repair is successful in three quarters of su ch infants if the wait is 3 months and/or the newborn weight has at le ast doubled. This repair appears to provide the best functional result , unless there is an anastomotic stricture. Before the 1970s, the surv ival rate was below 40%, but since the 1980s the rate has more than do ubled, to 90% in our series, regardless of the type of repair used. Co pyright (C) 1994 by W.B. Saunders Company