Staged repair improves outcome of high-risk premature infants with esophageal atresia and tracheoesophageal fistula

Abstract

Twenty-five high-risk premature infants weighing less than 2,000 g at birth (Waterson class C), were treated for esophageal atresia (EA) and tracheoesophageal fistula (TEF). If four patients with associated Trisomy 18 are excluded for whom definitive surgery was denied, 17 of 21 patients (81%) survived. Of significance is that 14 patients with EA and TEF underwent initial gastrostomy tube placement followed by either primary anastomosis or staged repair, depending on clinical status. Four of these infants with distal TEF who were considered low risk underwent a primary anastomosis with 100% survival. However, 3 of these 4 patients developed significant postoperative complications and 2 required subsequent Nissen fundoplication (50%). Ten reached at least 2,000 g in weight with 70% survival. In this group 3 neonates died before the definitive repair could be performed. Of the 7 who survived, only 2 incurred postoperative complications and only 1 patient required Nissen fundoplication (14%). Five other patients were found to have EA without TEF and underwent staged repair with 100% survival. Finally, one additional patient with H-type TEF underwent transcervical ligation and another with a congenital esophageal stenosis died of intracerebral hemorrhage prior to the institution of surgical therapy. Although the number in this series are small, these findings suggest that premature infants with EA and TEF incur a lesser morbidity when treated by a staged repair versus a primary anastomosis.