Gastroesophageal Reflux after Repair of Esophageal Atresia and Tracheoesophageal Fistula.

Abstract

Gastroesophageal reflux (GER) after repair of esophageal atresia and tracheoesophageal fistula (EA-TEF) is well documented. In order to clarify the effect of gastrostomy on GER after EA-TEF repair, two groups of patients, with and without gastrostomy, were compared.From 1978 to 1996, 63 consecutive patients with EA-TEF (Gross type C) underwent surgical correction without subsequent anastomotic leakage or recurrent TEF. Twenty-six patients underwent repair without gastrostomy and a routine gastrostomy was placed in 37. The two groups had similar clinical profiles and neither their mean esophageal gap between the proximal and distal esophagus nor their angle of His differed significantly. Ten patients (27.0%) with and six (23.1%) without gastrostomy developed GER and Nissen fundoplication was required in 6 of the former and 4 of the latter. There was no significant relationship between GER development and gastrostomy placement. The mean esophageal gaps in the GER and non-GER groups were 2.5 ± 0.9 and 1.2 ± 0.8cm, respectively, and they differed significantly (p<0.01). There was a significant relationship between the esophageal gap size and GER incidence (p<0.01). The mean angle of His was significantly greater in GER than non-GER patients and the angle of His correlated with the esophageal gap size.In conclusion, there appears to no relationship between GER development and gastrostomy placement, whereas there is a correlation between the esophageal gap and GER development.