ESOPHAGEAL ATRESIA WITH TRACHEO-ESOPHAGEAL FISTULA—A REVIEW OF CRITICAL CARE, ANESTHETIC AND SURGICAL MANAGEMENT

Abstract

We reviewed the critical and perioperative management of 57 newborns and infants with esophageal atresia (EA) and tracheoesophageal fistula (TEF) during the last 16 years (1970-1985). The common anomaly of proximal EA with distal TEF was present in 54; 3 had the less common H type fisutla. The major preoperative problem was pneumonia ± atelectasis. There was no relationship between intubation technique and subsequent ventilatory problems. Even though serious ventilatory problems after an initial gastrostomy have been reported, no such problem was found in this review. Invasive monitoring (arterial ± central venous lines) was used more often in recent years. When compared to previous reports the overall one-year mortality was significantly better for babies weighing ≤ 2.5 kgs (< 2.0 kgs = 50%; 2-2.5 kgs = 87%). Survival for babies > 2.5 kgs continues to be good (97%). Improved survival maybe related to better monitoring, improved surgical technique, cardiac and nutritional support. Prophylactic esophageal dilation of the repaired atretic segment was done routinely and may have decreased the incidence of chronic aspiration and mortality. However, there was a difference in mortality and morbidity between primary and staged repairs. With the latter, the mortality and morbidity was 8.9% and 89% respectively. With primary repair only 3.6% and 57%. The patients who had staged repair were of younger gestational age, weighed less and had a higher incidence of preoperative pulmonary problems.