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Primary Repair Without Routine Gastrostomy Is the Treatment of Choice for Neonates With Esophageal Atresia and Tracheoesophageal Fistula

Primary Repair Without Routine Gastrostomy Is the Treatment of Choice for Neonates With... Abstract • Gastrostomy and staged repair are techniques frequently recommended for the management of esophageal atresia with distal tracheoesophageal fistula (EA-TEF), especially for those infants at high risk. We describe 42 consecutive patients with EA-TEF treated during the past 8 years. Staged repair and preliminary gastrostomy were not routinely employed. Fifteen infants were considered to be at high risk (Waterston class C). Surgical treatment via an extrapleural approach consisted of fistula division and primary single-layer end-to-end esophageal anastomosis. Four patients required proximal esophageal circular myotomy. Four patients early in the series received a gastrostomy at or before definitive repair for various life-threatening indications. One patient had fistula division only and died before esophageal anastomosis was possible. Two neonates died before repair and another died after repair. The deaths in this series of patients were unrelated to EA-TEF. One patient developed a clinically significant anastomotic leak. Four patients required multiple dilatations for anastomotic stricture. Fundoplication was necessary in 3 patients with symptomatic gastroesophageal reflux. Our data demonstrate that excellent overall survival (90%) with low morbidity (15%) can be achieved using primary repair without preliminary gastrostomy in most neonates with EA-TEF. We believe that mortality in high-risk patients with EA-TEF is due to associated life-threatening anomalies. (Arch Surg. 1989;124:1188-1191) References 1. Leven NL. Congenital atresia of the esophagus with tracheoesophageal fistula: report of successful extrapleural ligation of fistulous communication and cervical esophagostomy . J Thorac Cardiovasc Surg . 1941;10:648-657. 2. Ladd WE. The surgical treatment of esophageal atresia and tracheoesophageal fistulas . N Engl J Med . 1944;230:625-637.Crossref 3. Randolph JG, Newman KD, Anderson KD. Current results in repair of esophageal atresia with tracheoesophageal fistula using physiologic status as a guide to therapy. Ann Surg. In press. 4. Pohlson EC, Schaller RT, Tapper D. Improved survival with primary anastomosis in the low birth weight neonate with esophageal atresia and tracheoesophageal fistula . J Pediatr Surg . 1988;23:418-421.Crossref 5. Martin LW, Alexander F. Esophageal atresia . Surg Clin North Am . 1985;65:1099-1113. 6. Waterston DJ, Carter REB, Aberdeen E. Oesophageal atresia: tracheooesophageal fistula: a study of survival in 218 infants . Lancet . 1962;1:819-822.Crossref 7. Holder TM, Ashcraft KW, Sharp RJ, Amoury RA. Care of infants with esophageal atresia, tracheoesophageal fistula, and associated anomalies . J Thorac Cardiovasc Surg . 1987;94:828-835. 8. Manning PB, Morgan RA, Coran AG, et al. Fifty years experience with esophageal atresia and tracheoesophageal atresia: beginning with Cameron Haight's first operation in 1935 . Ann Surg . 1986;204:446-451.Crossref 9. Tyson KRT. Primary repair of esophageal atresia without staging or preliminary gastrostomy . Ann Thorac Surg . 1976;21:378-381.Crossref 10. Schwartz MZ. An improved technique for circular myotomy in long gap esophageal atresia . J Pediatr Surg . 1983;18:833-834.Crossref 11. Coran AG. One stage repair of esophageal atresia in the high-risk neonate . Ann Thorac Surg . 1976;21:470-473.Crossref 12. Holder TM, MacDonald VG, Woolley MM. The premature or critically ill infant with esophageal atresia: increased success with a staged approach . J Thorac Cardiovasc Surg . 1962;44:344. 13. Bishop PJ, Klein MD, Philippart AI, Hixson DS, Hertzler SH. Transpleural repair of esophageal atresia without a primary gastrostomy: 240 patients treated between 1951 and 1983 . J Pediatr Surg . 1985;20:823-828.Crossref 14. Yeh ML, Sheu JC, Chang PY, Chen CC. Treatment of esophageal atresia with distal tracheoesophageal fistula: Are gastrostomy and prophylactic esophageal dilatation necessary? Int Surg . 1986;71:169-170. 15. Haight C, Towsley HA. Congenital atresia of the esophagus with tracheoesophageal fistula: extrapleural ligation of fistula and end-to-end anastomosis of esophageal segments . Surg Gynecol Obstet . 1943;76:672-688. 16. Wise WE, Caniano DA, Harmel RP. Tracheoesophageal anomalies in Waterston C neonates: a 30-year perspective . J Pediatr Surg . 1987;22:526-529.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Primary Repair Without Routine Gastrostomy Is the Treatment of Choice for Neonates With Esophageal Atresia and Tracheoesophageal Fistula

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References (17)

Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1989.01410100090015
Publisher site
See Article on Publisher Site

Abstract

Abstract • Gastrostomy and staged repair are techniques frequently recommended for the management of esophageal atresia with distal tracheoesophageal fistula (EA-TEF), especially for those infants at high risk. We describe 42 consecutive patients with EA-TEF treated during the past 8 years. Staged repair and preliminary gastrostomy were not routinely employed. Fifteen infants were considered to be at high risk (Waterston class C). Surgical treatment via an extrapleural approach consisted of fistula division and primary single-layer end-to-end esophageal anastomosis. Four patients required proximal esophageal circular myotomy. Four patients early in the series received a gastrostomy at or before definitive repair for various life-threatening indications. One patient had fistula division only and died before esophageal anastomosis was possible. Two neonates died before repair and another died after repair. The deaths in this series of patients were unrelated to EA-TEF. One patient developed a clinically significant anastomotic leak. Four patients required multiple dilatations for anastomotic stricture. Fundoplication was necessary in 3 patients with symptomatic gastroesophageal reflux. Our data demonstrate that excellent overall survival (90%) with low morbidity (15%) can be achieved using primary repair without preliminary gastrostomy in most neonates with EA-TEF. We believe that mortality in high-risk patients with EA-TEF is due to associated life-threatening anomalies. (Arch Surg. 1989;124:1188-1191) References 1. Leven NL. Congenital atresia of the esophagus with tracheoesophageal fistula: report of successful extrapleural ligation of fistulous communication and cervical esophagostomy . J Thorac Cardiovasc Surg . 1941;10:648-657. 2. Ladd WE. The surgical treatment of esophageal atresia and tracheoesophageal fistulas . N Engl J Med . 1944;230:625-637.Crossref 3. Randolph JG, Newman KD, Anderson KD. Current results in repair of esophageal atresia with tracheoesophageal fistula using physiologic status as a guide to therapy. Ann Surg. In press. 4. Pohlson EC, Schaller RT, Tapper D. Improved survival with primary anastomosis in the low birth weight neonate with esophageal atresia and tracheoesophageal fistula . J Pediatr Surg . 1988;23:418-421.Crossref 5. Martin LW, Alexander F. Esophageal atresia . Surg Clin North Am . 1985;65:1099-1113. 6. Waterston DJ, Carter REB, Aberdeen E. Oesophageal atresia: tracheooesophageal fistula: a study of survival in 218 infants . Lancet . 1962;1:819-822.Crossref 7. Holder TM, Ashcraft KW, Sharp RJ, Amoury RA. Care of infants with esophageal atresia, tracheoesophageal fistula, and associated anomalies . J Thorac Cardiovasc Surg . 1987;94:828-835. 8. Manning PB, Morgan RA, Coran AG, et al. Fifty years experience with esophageal atresia and tracheoesophageal atresia: beginning with Cameron Haight's first operation in 1935 . Ann Surg . 1986;204:446-451.Crossref 9. Tyson KRT. Primary repair of esophageal atresia without staging or preliminary gastrostomy . Ann Thorac Surg . 1976;21:378-381.Crossref 10. Schwartz MZ. An improved technique for circular myotomy in long gap esophageal atresia . J Pediatr Surg . 1983;18:833-834.Crossref 11. Coran AG. One stage repair of esophageal atresia in the high-risk neonate . Ann Thorac Surg . 1976;21:470-473.Crossref 12. Holder TM, MacDonald VG, Woolley MM. The premature or critically ill infant with esophageal atresia: increased success with a staged approach . J Thorac Cardiovasc Surg . 1962;44:344. 13. Bishop PJ, Klein MD, Philippart AI, Hixson DS, Hertzler SH. Transpleural repair of esophageal atresia without a primary gastrostomy: 240 patients treated between 1951 and 1983 . J Pediatr Surg . 1985;20:823-828.Crossref 14. Yeh ML, Sheu JC, Chang PY, Chen CC. Treatment of esophageal atresia with distal tracheoesophageal fistula: Are gastrostomy and prophylactic esophageal dilatation necessary? Int Surg . 1986;71:169-170. 15. Haight C, Towsley HA. Congenital atresia of the esophagus with tracheoesophageal fistula: extrapleural ligation of fistula and end-to-end anastomosis of esophageal segments . Surg Gynecol Obstet . 1943;76:672-688. 16. Wise WE, Caniano DA, Harmel RP. Tracheoesophageal anomalies in Waterston C neonates: a 30-year perspective . J Pediatr Surg . 1987;22:526-529.Crossref

Journal

Archives of Surgery – American Medical Association

Published: Oct 1, 1989

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