Pj. Healey et al., DELAYED PRIMARY REPAIR OF ESOPHAGEAL ATRESIA WITH TRACHEOESOPHAGEAL FISTULA - IS IT WORTH THE WAIT, Archives of surgery, 133(5), 1998, pp. 552-556
Objective: To characterize a successful approach to the management of
infants with long-gap esophageal atresia (EA) with tracheoesophageal f
istula (TEF), significant prematurity with respiratory distress syndro
me (RDS), or both, so as to preserve the native esophagus. Design: A r
eview of the medical records and office charts of a cohort of patients
with EA and TEF. Setting: A tertiary care children's hospital affilia
ted with a major university. Patients: A total of 118 children with EA
and TEF admitted from February 1986 through December 1996. All of the
patients diagnosed as having EA and TEF during this period were inclu
ded. Intervention: Of the 118 infants, 88 received primary repair of E
A and TEF within 48 hours of birth. An additional 23 children had the
TEF divided and a gastrostomy placed secondary to (1) severe RDS and p
rematurity (n = 6), (2) long-gap EA (gap length >4 cm or the upper pou
ch above the thoracic inlet (n = 10), or (3) associated cardiac defect
s (n = 7). Delayed primary EA repair was done when the RDS resolved or
the gap length was 2 cm or less. Main Outcome Measures: Successful an
astomosis of native esophagus. Comparison of incidence of gastro esoph
ageal reflux; anastomotic complications, or survival between groups un
dergoing primary or delayed repair. Results: Primary EA was accomplish
ed in 88 patients. Delayed EA was successfully accomplished in 18 of t
he 19 surviving patients within 5 months, thereby preserving the nativ
e esophagus in all surviving infants. There was no difference in anast
omotic complications, gastroesophageal reflux, or survival when the de
layed group was compared with those who had a primary repair. Conclusi
ons: Using delayed EA repair, all children with EA and TEF, regardless
of gap length, can have their esophagus preserved. The primary cause
of mortality was the association of a severe cardiac anomaly with EA a
nd TEF.