Atrezije jednjaka - savremeni pristup lečenju

Abstract

Esophageal atresia refers to a congenitally interrupted esophagus, with one or more fistulae present between the malformed esophagus and the trachea. The most frequent type is the one with distal tracheoesophageal fistula. If not diagnosed in time, it could cause severe respiratory complications , due to the aspiration of saliva, or direct flow of gastric secretions from below into the tracheobronchial tree. Surgical treatment of esophageal atresia demands a very precise operative technique, because of very limited possibilities for redo procedures. Results in the treatment of esophageal atresia, associated anomalies and postoperative complications are used in evaluation of both expert achievements of surgical team and institutional recommendations for certain pediatric hospitals. That is why the aim of the study is to evaluate our success in surgical treatment and to make a diagnostic and therapeutic algorithm for esophageal atresia. A retrospective study included 294 neonates treated from 1971-2013. The data are analyzed by comparing the incidence of different types of esophageal atresia, association with other congenital anomalies, treatment modalities of long-gap esophageal atresia and postoperative complications , as well as the outcome and survival rate over time. The results are analyzed using descriptive statistical method. The incidence of common esophageal atresia with distal tracheoesophageal fistula was 92,7 %; 5,1% with no fistula, 0,5% with two fistulae and 1,7% of H-type anomaly. The long-gap esophageal atresia was surgically treated in 3,4 % of cases. Various other congenital anomalies were associated in 48% of cases. The incidence of early complications including an anastomotic leak was about 5%; 1% of recurrent tracheoesophageal fistula and 7% of anastomotic structures. Gastroesophageal reflux as the main late postoperative complication, particularly problematic in patients with esophageal atresia occurs in 10% of cases in our series of patients. Developing surgical experience and neonatal intensive care units, the survival rate achieved 98%, which has certainly improved the outcome of surgical treatment, lowered the rate of postoperative complications and improved the quality of life, because most of the children who undergo a successful repair of esophageal atresia are relatively healthy.