Esophageal Atresia. Factors Influendng Outcome in Recent Era

Summary

The aim of the study was to analýze mortality, incidence of complications and influence of various prognostic factors on the outcome of patients with esophageal atresia.A retrospective analysis of the records of 109 consecutive cases of esophageal atresia and/or tracheoesophageal tlstula operated in 1992 - 2001 was undertaken. Primary anastomosis was achieved in 68 (62.4%) patients, in 7 (6.4%) procedures aimed at esophageal substitution in the future were performed and in 34 (31.2%) a delayed anastomosis was primarily planned.Major associated anomalies were found in 55 (50.4%), cardiac anomalies in 19 (17.4%), and more than one associated anomaly in 16 (14.7%) patients. The most frequent surgical complication was an anastomotic leak in 11.9 %, septic complications were the most frequent overall and occurred in 66 (60.5 %) patients. Gastroesophageal reflux was diagnosed in 30.3% and treated surgically in 14.7% of infants.The overall mortality was 20.2% (22 patients). The most frequent cause of death was sepsis and/or pneumonia. Long gap esophageal atresia was not found to be a significant factor in mortality.Factors significantly increasing mortality were birth weight below 2000 g (OR 3.94), cardiac anomalies (OR 3.95), and mechanical ventilation before operation (OR 2.97). Analysis of the outcome suggests that improved stratégy in treating infants with multiple anomalies and more frequent attempts at primary anastomosis even in children in sub optimal generál condition at diagnosis could decrease mortality.

Key words:
esophageal atresia, congenital anomalies, gastroesophageal reflux, mortality