Selective surgical management based upon clinical status in infants with esophageal atresia

Abstract

Fifty-six patients with esophageal atresia and distal tracheoesophageal fistula (Vogt-Gross type C) have been treated at our institution since 1966. The methods of treatment have been individualized according to gestational age, birth weight, pulmonary status, and coexistence of other major anomalies. Three distinct approaches have evolved: Immediate primary repair is reserved for infants weighing more than 2 kilograms who have no major anomalies and satisfactory pulmonary status. Delayed primary repair is used in infants of adequate weight (more than 2 kilograms) who have significant but reversible pulmonary changes, with anticipated recovery within I week, and in those in whom several days are required for evaluation of an associated congenital anomaly; we temporize by upper pouch suction, gastrostomy, and antibiotics. Staged repair is used in premature and severely distressed infants as well as in those with cardiac lesions of surgical priority; staging consists of upper pouch suction, gastrostomy, retropleural division of the fistula, or gastric division, with subsequent transpleural repair in 4 to 8 weeks. The surgical approach to each of these infants has been selected after assessment of all aspects of their clinical condition. Flexibility in treatment, which is predicated upon previously established criteria, seems superior to any single surgical plan.