Factors affecting the short-term outcome of open surgical repair of esophageal atresia and tracheoesophageal fistula through an extrapleural approach with azygous vein sparing

Abstract

Background Congenital esophageal atresia (EA) and tracheoesophageal fistula (TEF) are common congenital anomalies, affecting one in 2400–4500 neonates. The surgical management of EA/TEF has evolved over the last 60 years and is associated with a progressive improvement in survival. In this study, we performed open surgical repair of EA with TEF, type (Gross C). In all cases, we proceeded with the azygous sparing retropleural approach and early extubation if circumstances permitted. In all cases, we studied all other factors affecting the results in our institute. Aim To evaluate the immediate outcome of open surgical repair of the EA/TEF (Gross C) sparing azygous vein through the retropleural approach. Patients and methods In this prospective study, 26 neonates diagnosed with EA/TEF were admitted to NICU and prepared for surgery. All patients were operated on through right thoracotomy with an extrapleural approach and preservation of the azygous vein. Perioperative factors affecting the outcome were evaluated and recorded. Results Of the 26 neonates operated on, 15 were males and 11 were females. The mean age of the neonates at operation was 5.5 days. Their mean weight was 2875 g. Twenty-one (80.7%) cases survived and were discharged, whereas five (19.2%) cases died in the early postoperative period because of sepsis, respiratory, and ventilator complications. The mean preoperative C-reactive protein (CRP) level was 112. Leakage as a potential complication occurred in eight out of 26 (30.7%) cases. Immediate extubation was achieved in 12 (46.1%) cases. The operative time ranged from 45 to 100 min and the mean hospital stay was 12 days. Conclusion Open surgical repair of EA/TEF by the extrapleural approach, with preservation of the azygous vein and if possible immediate or early extubation, leads to good results if performed by an experienced surgeon with respect to other perioperative factors.