A prospective study of gap length in esophageal atresia with tracheoesophageal fistula, and comparison of outcome of patients in long gap and short gap lengths

Abstract

Purpose: In this study our purpose is to measure the gap length between esophageal atresia and tracheoesophageal fistula and to identify weather different gap lengths play any role in outcome of the patients. Introduction: Tracheoesophageal fistula is an abnormal fistula communication between the oesophagus and trachea. Tracheoesophageal fistula is common surgically correctable congenital anomaly for which newborn admitted in hospital. Outcome of TEF repair depends on many factor like maturity, birth weight, and age at time of presentation, general condition, presence or absence of pneumonia, associated anomaly and gap length. One of such factor is gap length between EA and TEF. We were studding the outcome of the patients with corresponding gap lengths. Material and Method: A total no. of 50 cases were studied during the period of 2 years from November 2017 to November 2019. The cases were divided into two groups according to the measured gap lengths Group A gap length 2 cm (long gap length) total 22 of total 50 cases. The gap between the two oesophageal pouches was meticulously measured with the help of a Vernier calliper and divider scale intra operatively before ligating the TE fistula and before upper pouch mobilization. The final outcome was recorded as the proportion of survivors in these two gap length groups at the time of discharge from the hospital. Result: Most of the reported cases were full term (68%), low birth weight beby (76%) presented at pnd 1(56%) and male to female ratio is nearly equal. Associated anomaly were arm(55%).outcome were assessed, In group A mortality rate is 64.28% and survival rate is 35.71% while in group B mortality rate 90.99%and survival rate is 9.09% Overall survival rate found to be significantly higher in patients with short gap length as compared to long gap length. Post-operative complication were also studied like sepsis, anastomotic leak, vomiting, respiratory distress, dysphagia, recurrent pneumonia and failure to thrive. Conclusion: Mortality rate was found to have a direct proportional relationship with the gap length... Overall mortality found to be higher in patients with long gap length as compared to short gap length, thus concluded that gap length is an important predictor of the outcome of treatment or survival of the patients in cases of oesophageal atresia with tracheoesophageal fistula.