Skip to main content
SpringerLink
Log in

Outcome in neonates with esophageal atresia treated over the last 20 years

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

We evaluated the outcome in infants with esophageal atresia (EA) treated in our department over the last two decades. The medical records of 147 infants treated from 1986 to 2005 were reviewed. Patient characteristics, associated anomalies, surgery and complications were recorded. We divided the material into two time-periods: 1986–1995 and 1996–2005; 125 patients or parents were interviewed regarding gastrointestinal function, respiratory symptoms and education. The incidence of major cardiac defects increased from 23 to 29% and the overall survival increased from 87 to 94%. Using Spitz’ classification survival increased from 93.5 to 100% in group I and from 68.4 to 77.8% in group II. In group III, during the second time period, survival was 100% in three patients. The incidence of anastomotic leakage and recurrent fistula did not change over time. The rate of anastomotic strictures increased from 53 to 59% between the two time-periods. A primary anastomosis could be done in 85% of the patients during the second period versus 78% of the patients during the first period. Anti-reflux surgery was done in only 11 and 9%, respectively, during the two time-periods. In patients who were 16–20 years old, 40–50% had gastrointestinal and respiratory symptoms. Ninety percent of the patients attended normal school. The major difference between the periods 1986–1995 and 1996–2005 was an increased survival despite an increased incidence of major cardiac defects. Gastrointestinal and respiratory symptoms were frequent. Long-term follow-up and treatment of complications of esophageal atresia is important for this patient group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Spitz L (2006) Esophageal atresia. Lessons I have learned in a 40-year experience. J Pediatr Surg 41:1635–1640

    Article  PubMed  Google Scholar 

  2. Haight C, Towsley HA (1943) Congenital atresia of the esophagus with tracheoesophageal fistula. Extrapleural ligation of fistula and end-to-end anastomosis of esophageal segments. Surg Gynecol Obstet 76:672–688

    Google Scholar 

  3. Lopez PJ, Keys C, Pierro A, Drake DP, Kiely EM, Curry JI, Spitz L (2006) Oesophageal atresia: Improved outcome in high-risk groups? J Pediatr Surg 41:331–334

    Article  PubMed  Google Scholar 

  4. Tonz M, Kohli S, Kaiser G (2004) Oesophageal atresia: what has changed in the last 3 decades? Pediatr Surg Int 20:768–772

    Article  PubMed  Google Scholar 

  5. Orford J, Cass DT, Glasson MJ (2004) Advances in the treatment of oesophageal atresia over three decades: the 1970s and the 1990s. Pediatr Surg Int 20:402–407

    Article  PubMed  Google Scholar 

  6. Konkin DE, O’Hali WA, Webber EM, Blair GK (2003) Outcomes in esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 38:1726–1729

    Article  PubMed  Google Scholar 

  7. Deurloo JA, Ekkelkamp S, Schoorl M, Heij HA, Aronson DC (2002) Esophageal atresia: historical evolution of management and results in 371 patients. Ann Thorac Surg 73:267–272

    Article  PubMed  Google Scholar 

  8. Choudhury SR, Ashcraft KW, Sharp RJ, Murphy JP, Snyder CL, Sigalet DL (1999) Survival of patients with esophageal atresia: influence of birth weight, cardiac anomaly, and late respiratory complications. J Pediatr Surg 34:70–73 (discussion 74)

    Article  PubMed  CAS  Google Scholar 

  9. Koivusalo A, Pakarinen MP, Turunen P, Saarikoski H, Lindahl H, Rintala RJ (2005) Health-related quality of life in adult patients with esophageal atresia—a questionnaire study. J Pediatr Surg 40:307–312

    Article  PubMed  Google Scholar 

  10. Tomaselli V, Volpi ML, Dell’Agnola CA, Bini M, Rossi A, Indriolo A (2003) Long-term evaluation of esophageal function in patients treated at birth for esophageal atresia. Pediatr Surg Int 19:40–43

    PubMed  CAS  Google Scholar 

  11. Little DC, Rescorla FJ, Grosfeld JL, West KW, Scherer LR, Engum SA (2003) Long-term analysis of children with esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 38:852–856

    Article  PubMed  CAS  Google Scholar 

  12. Somppi E, Tammela O, Ruuska T, Rahnasto J, Laitinen J, Turjanmaa V, Jarnberg J (1998) Outcome of patients operated on for esophageal atresia: 30 years’ experience. J Pediatr Surg 33:1341–1346

    Article  PubMed  CAS  Google Scholar 

  13. Sillen U, Hagberg S, Rubenson A, Werkmaster K (1988) Management of esophageal atresia: review of 16 years’ experience. J Pediatr Surg 23:805–809

    Article  PubMed  CAS  Google Scholar 

  14. Rokitansky AM, Kolankaya VA, Seidl S, Mayr J, Bichler B, Schreiner W, Engels M, Horcher E, Lischka A, Menardi G et al (1993) Recent evaluation of prognostic risk factors in esophageal atresia—a multicenter review of 223 cases. Eur J Pediatr Surg 3:196–201

    PubMed  CAS  Google Scholar 

  15. Louhimo I, Lindahl H (1983) Esophageal atresia: primary results of 500 consecutively treated patients. J Pediatr Surg 18:217–229

    Article  PubMed  CAS  Google Scholar 

  16. Waterston DJ, Carter RE, Aberdeen E (1962) Oesophageal atresia: tracheo-oesophageal fistula. A study of survival in 218 infants. Lancet 1:819–822

    Article  PubMed  CAS  Google Scholar 

  17. Teich S, Barton DP, Ginn-Pease ME, King DR (1997) Prognostic classification for esophageal atresia and tracheoesophageal fistula: Waterston versus Montreal. J Pediatr Surg 32:1075–1079 discussion 1079–1080

    Article  PubMed  CAS  Google Scholar 

  18. Spitz L, Kiely EM, Morecroft JA, Drake DP (1994) Oesophageal atresia: at-risk groups for the 1990s. J Pediatr Surg 29:723–725

    Article  PubMed  CAS  Google Scholar 

  19. Sharma AK, Shekhawat NS, Agrawal LD, Chaturvedi V, Kothari SK, Goel D (2000) Esophageal atresia and tracheoesophageal fistula: a review of 25 years’ experience. Pediatr Surg Int 16:478–482

    Article  PubMed  CAS  Google Scholar 

  20. Kovesi T, Rubin S (2004) Long-term complications of congenital esophageal atresia and/or tracheoesophageal fistula. Chest 126:915–925

    Article  PubMed  Google Scholar 

  21. Chittmittrapap S, Spitz L, Kiely EM, Brereton RJ (1990) Anastomotic stricture following repair of esophageal atresia. J Pediatr Surg 25:508–511

    Article  PubMed  CAS  Google Scholar 

  22. Engum SA, Grosfeld JL, West KW, Rescorla FJ, Scherer LR III (1995) Analysis of morbidity and mortality in 227 cases of esophageal atresia and/or tracheoesophageal fistula over two decades. Arch Surg 130:502–508 (discussion 508–509)

    PubMed  CAS  Google Scholar 

  23. Kirkpatrick JA, Cresson SL, Pilling GP IV (1961) The motor activity of the esophagus in association with esophageal atresia and tracheoesophageal fistula. Am J Roentgenol Radium Ther Nucl Med 86:884–887

    PubMed  CAS  Google Scholar 

  24. Cheng W, Spitz L, Milla P (1997) Surface electrogastrography in children with esophageal atresia. Pediatr Surg Int 12:552–555

    Article  PubMed  CAS  Google Scholar 

  25. Montgomery M, Escobar-Billing R, Hellstrom PM, Karlsson KA, Frenckner B (1998) Impaired gastric emptying in children with repaired esophageal atresia: a controlled study. J Pediatr Surg 33:476–480

    Article  PubMed  CAS  Google Scholar 

  26. Davies MR (1996) Anatomy of the extrinsic motor nerve supply to mobilized segments of the oesophagus disrupted by dissection during repair of oesophageal atresia with distal fistula. Br J Surg 83:1268–1270

    Article  PubMed  CAS  Google Scholar 

  27. Qi BQ, Merei J, Farmer P, Hasthorpe S, Myers NA, Beasley SW, Hutson JM (1997) The vagus and recurrent laryngeal nerves in the rodent experimental model of esophageal atresia. J Pediatr Surg 32:1580–1586

    Article  PubMed  CAS  Google Scholar 

  28. Cheng W, Bishop AE, Spitz L, Polak JM (1999) Abnormal enteric nerve morphology in atretic esophagus of fetal rats with adriamycin-induced esophageal atresia. Pediatr Surg Int 15:8–10

    Article  PubMed  CAS  Google Scholar 

  29. Kubiak R, Spitz L, Kiely EM, Drake D, Pierro A (1999) Effectiveness of fundoplication in early infancy. J Pediatr Surg 34:295–299

    Article  PubMed  CAS  Google Scholar 

  30. Holcomb GW III, Rothenberg SS, Bax KM, Martinez-Ferro M, Albanese CT, Ostlie DJ, van Der Zee DC, Yeung CK (2005) Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula: a multi-institutional analysis. Ann Surg 242:422–428 (discussion 428–430)

    PubMed  Google Scholar 

  31. Ure BM, Slany E, Eypasch EP, Weiler K, Troidl H, Holschneider AM (1998) Quality of life more than 20 years after repair of esophageal atresia. J Pediatr Surg 33:511–515

    Article  PubMed  CAS  Google Scholar 

  32. Agrawal L, Beardsmore CS, MacFadyen UM (1999) Respiratory function in childhood following repair of oesophageal atresia and tracheoesophageal fistula. Arch Dis Child 81:404–408

    Article  PubMed  CAS  Google Scholar 

  33. Bouman NH, Koot HM, Hazebroek FW (1999) Long-term physical, psychological, and social functioning of children with esophageal atresia. J Pediatr Surg 34:399–404

    Article  PubMed  CAS  Google Scholar 

  34. Lindahl H (1984) Long-term prognosis of successfully operated oesophageal atresia-with aspects on physical and psychological development. Z Kinderchir 39:6–10

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, University Hospital, SE-751 85, Uppsala, Sweden

    Helene Engstrand Lilja & Tomas Wester

Authors
  1. Helene Engstrand Lilja
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomas Wester
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Helene Engstrand Lilja.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lilja, H.E., Wester, T. Outcome in neonates with esophageal atresia treated over the last 20 years. Pediatr Surg Int 24, 531–536 (2008). https://doi.org/10.1007/s00383-008-2122-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-008-2122-z

Keywords

Search

Navigation