Oesophageal atresia and tracheo-oesophageal fistula: an experience from a developing country

ABSTRACT

To evaluate the various factors influencing the survival of neonates with oesophageal atresia with distal tracheo-oesophageal fistula [EA with TEF]. A descriptive case series. Department of Paediatric Surgery. National Institute of Child Health, Karachi from January 2003 to December 2003. A descriptive case series spanned over one year was conducted at the Department of Paediatric Surgery, National Institute of Child Health, Karachi. The baby's condition was classified according to Waterston's classification. All patients who survived were discharged when they were stable and fit for nursing at home. A routine follow up was advised, initially monthly and later at greater intervals. During one year period 45 patients of aesophageal atresia with distal tracheo-oesohageal fistula were managed. Among these twenty seven [60%] were male and eighteen [40%] female babies. The age at presentation ranged between 3 hours to 20 days with a median age 4 days. The weight at presentation ranged between 1.2 kg to 3.5 kg with a mean of 2.3 +/- 0.5. According to Waterston classification nine [20%] of these were in group-A, twenty-four [53%] in group-B and twelve [27%] in group-C. Six [13%] died preoperatively. In nine patients circular myotomy was done due to long gap. Postoperatively five patients needed ventilatory support. Postoperative course was uneventful in fifteen patients. Twenty four [61%] patients developed minor and major complications. Postoperatively thirteen [28.8%] patients died. Cause of death was mainly sepsis. The over all mortality was 42.2%. A high overall mortality is of concern but post operative survival of about 66.6% [overall 57.8%] is encouraging. Early referral seems to be an important preventable factor for which awareness program at primary health care level is to be stressed