Oesophageal atresia: role of gap length in determining the outcome

ABSTRACT

Twenty neonates born with oesophageal atresia and tracheoesophageal fistula over a period of two years were managed and the role of gap length between the two ends of oesophagus on the outcome was studied. Twelve [60%] were males and 8 [40%] were females. Body weight ranged from 2.2 kg to 3 kg. Only 2 [10%] were received within 24 hours of birth. Six [30%] were received within 48 hours of birth, 3 [15%] were 3 days old and 9 [45%] were 6 days old at the time of admission. Gap between the upper pouch and the lower fistulous end of oesophagus was 2cm in 4 [20%], >2cm but 3cm in 8 cases [40%] and >3 cm in 8 [40%] cases. Preoperatively chest infection was found in 16 [80%] cases. Associated congenital malformations were found in 7 [35%] cases. Primary anastomsis of Oesophagus was performed in all the cases. In order to relieve the tension on the anastomosis upper segment circular myotomy was performed in 8 [40%] cases. Post operative survival was 45%. Early postoperative complications among survivors included anastomotic leak in 3 [33%], pneumonia in 2 [22%] and wound infection in 2 [22%] cases. Late complications included gastroesophageal reflux in 7 [78%] and stricture formation in 6 [67%] cases. Major cause of death was sepsis secondary to chest infection. Authors conclude that prognosis of oesophageal atresia-tracheoesophageal fistula is excellent in children born with gap length 2cm. Morbidity and mortality increases proportionately as gap length increases beyond 2 cm