Long-term results following repair of esophageal atresia by end-to-side anastomosis and ligation of the tracheoesophageal fistula

Abstract

We conducted a 12-yr retrospective review of 38 patients with esophageal atresia and a distal tracheoesophageal fistula (TEF) treated by end-to-side anastomosis and ligation of the TEF to correlate initial with long-term results. Overall survival rate was 87%, the leak rate 18%, and the stricture rate 8%. Three of the first 18 infants has a recurrent TEF, but none occurred in the subsequent 20 patients. Sixteen of 29 patients with long-term followup had respiratory complications during the first year, but only three have had continued problems since that age. All patients followed for longer than 1 yr take a regular diet with only four having occasional regurgitation episodes. Weight is above the fifth percentile in all but three girls from Waterston group C, and height is above the 10th percentile in all but four girls. Esophagogastric cine fluoroscopy in 23 patients revealed anastomotic narrowing in three (10%), abnormal motility in 20 (80%), and gastroesophageal reflux in five (22%). Only one of the latter group has required an antireflux procedure. Seventeen endoscopic procedures were performed in seven patients to retrieve an ingested solid foreign body, but subsequent esophagram showed anastomotic narrowing in only two patients. From this study, we conclude that end-to-side repair has a low incidence of recurrent TEF with none detected during the period of long-term followup. Respiratory complications occur frequently during the first year but thereafter patients have few pulmonary problems. Growth and development are normal; esophageal stricture and gastroesophageal reflux are uncommon, although motility disturbances are frequently encountered. We conducted a 12-yr retrospective review of 38 patients with esophageal atresia and a distal tracheoesophageal fistula (TEF) treated by end-to-side anastomosis and ligation of the TEF to correlate initial with long-term results. Overall survival rate was 87%, the leak rate 18%, and the stricture rate 8%. Three of the first 18 infants has a recurrent TEF, but none occurred in the subsequent 20 patients. Sixteen of 29 patients with long-term followup had respiratory complications during the first year, but only three have had continued problems since that age. All patients followed for longer than 1 yr take a regular diet with only four having occasional regurgitation episodes. Weight is above the fifth percentile in all but three girls from Waterston group C, and height is above the 10th percentile in all but four girls. Esophagogastric cine fluoroscopy in 23 patients revealed anastomotic narrowing in three (10%), abnormal motility in 20 (80%), and gastroesophageal reflux in five (22%). Only one of the latter group has required an antireflux procedure. Seventeen endoscopic procedures were performed in seven patients to retrieve an ingested solid foreign body, but subsequent esophagram showed anastomotic narrowing in only two patients. From this study, we conclude that end-to-side repair has a low incidence of recurrent TEF with none detected during the period of long-term followup. Respiratory complications occur frequently during the first year but thereafter patients have few pulmonary problems. Growth and development are normal; esophageal stricture and gastroesophageal reflux are uncommon, although motility disturbances are frequently encountered.