Abstract
BackgroundThe aim of this study was to evaluate anastomotic complications after primary one-staged esophageal atresia (EA) repair relating to the patients` gestational age (GA).MethodsRetrospective data analyses of patients who underwent closure of tracheoesophageal fistula (TEF) and primary esophageal anastomosis from 01/2007 to 12/2018 in two pediatric surgical centers. Exclusion of EA other than Gross type C, long-gap EA, minimal invasive or staged approach. Postoperative complications during the first year of life were assessed. Associated malformations, the incidence of infant respiratory distress syndrome (IRDS) and intraventricular bleeding were analyzed.ResultsInclusion of 75 patients who underwent primary EA repair. Low GA was associated with significantly lower incidence of anastomotic complications (p = 0.019, r = 0.596, 95% CI 0.10–0.85). Incidence of anastomotic leakage (0% vs. 5.5%; p = 0.0416), recurrent TEF (0% vs. 5.5%; p = 0.0416) und anastomotic stricture (0% vs. 14.5%; p = 0.0019) was significantly lower in patients < 34 gestational weeks. Incidence of IRDS (55% vs. 0%; p < 0.0001) and intraventricular bleeding (25% vs. 3.6%; p = 0.0299) was significantly higher in patients < 34 gestational weeks.ConclusionsDespite prematurity-related morbidity, low GA did not adversely affect surgical outcome after primary EA repair. Low GA was even associated with a better anastomotic outcome indicating feasibility and safety of primary esophageal reconstruction.
Highlights
The aim of this study was to evaluate anastomotic complications after primary one-staged esophageal atresia (EA) repair relating to the patientsgestational age (GA)
Long-gap EA was defined as Gross type A and B, and type C presenting with a long distance between the upper and lower pouch impeding the formation of a primary esophageal anastomosis
The remaining patients with birth weights < 2500 g were categorized according to the current standard definition as low birth weight (LBW), very low birth weight (VLBW), and extremely low birth weight (ELBW) [28]
Summary
The aim of this study was to evaluate anastomotic complications after primary one-staged esophageal atresia (EA) repair relating to the patientsgestational age (GA). Prematurity, birth weight and/or additional anomalies are usually considered crucial factors in determing the outcome of EA/TEF patients [3, 5, 6, 8, 9]. Several authors postulated that staged repair of EA/ TEF including primary TEF closure and secondary, delayed esophageal anastomosis in premature infants with low birth weights resulted in a lower rate of anastomotic complications, and should be considered the preferred surgical approach in this group of patients [4, 5]. In obstetric and neonatal practice, the patientsgestational age (GA) is considered to be a more relevant maturational and physiologic factor than body weight [20,21,22]
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