Treatment of Esophageal Atresia With a Short Proximal Esophageal Segment

Abstract

ESOPHAGEAL atresia occurs once in approximately every 4,000 births. Because this anomaly is uncommon, few medical centers have had sufficient experience to make a reliable analysis of the results of operative treatment. The Surgical Section of the American Academy of Pediatrics recently surveyed the results obtained from observation of 916 patients who had esophageal atresia with tracheoesophageal fistulas to the distal esophageal segments. 1 In the retropleural and transpleural approaches to the esophageal anastomosis there was no difference in the incidence of anastomotic leakage. However, when the anastomosis leaks into the retropleural space, infection is confined, extensive empyema is prevented, and the survival rate (60% vs 37%) is considerably higher than in the transpleural approach (Fig 1). Furthermore, the overall survival rate is better in retropleural anastomosis without leakage (78% vs 72%). This study as well as others have shown that premature infants have a poorer survival rate than full-term