Thirty-five-year institutional experience with end-to-side repair for esophageal atresia

Arch Surg. 2004 Apr;139(4):371-4; discussion 374. doi: 10.1001/archsurg.139.4.371.

Abstract

Hypothesis: End-to-side repair (ES) with ligation of the tracheoesophageal fistula (TEF) reduces the risks of stricture and gastroesophageal reflux disease requiring operation compared with the end-to-end repair of esophageal atresia and distal TEF.

Design: Case series with institutional and historical control subjects.

Setting: Referral children's hospital.

Patients: One hundred thirty-four infants diagnosed as having esophageal atresia and distal TEF between June 30, 1968, and July 1, 2003.

Interventions: Ninety-six infants having ES and 38 having end-to-end repair.

Main outcome measures: Patients were studied for overall survival, surgical complications, and well-being during the first year of life.

Results: Survival was 95% vs 90% (patients undergoing ES vs end-to-end repair). Complications included anastomotic leak, 8% vs 13%; recurrent TEF, 7% vs 3%, with only 1 recurrence in the last 28 patients having ES; anastomotic stricture (requiring dilatation), 5% vs 13%; gastroesophageal reflux disease requiring operation, 6% vs 18%; and esophageal dysmotility, which was present following nearly all ES and end-to-end procedures. Tracheomalacia-related respiratory symptoms following ES decreased from 50% to 11% at 1 year of age. Age-appropriate diet following ES was achieved in 93% by 1 year; 5% experienced occasional dysphagia or choking episodes.

Conclusions: The ES operation is accompanied by a reduced rate of stricture and gastroesophageal reflux disease requiring operation compared with end-to-end repair. Earlier concerns regarding an unacceptable risk of recurrent TEF were not substantiated.

Publication types

  • Comparative Study

MeSH terms

  • Anastomosis, Surgical
  • Esophageal Atresia / complications
  • Esophageal Atresia / surgery*
  • Esophageal Stenosis / etiology
  • Gastroesophageal Reflux / etiology
  • Humans
  • Infant
  • Infant, Newborn
  • Retrospective Studies
  • Surgical Procedures, Operative / adverse effects
  • Surgical Procedures, Operative / methods*
  • Survival Analysis
  • Tracheoesophageal Fistula / complications
  • Tracheoesophageal Fistula / surgery*
  • Treatment Outcome