Early and Long Term Outcome in Children with Esophageal Atresia Treated Over the Last 22 Years

 

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Abstract

Background: The survival of infants born with esophageal atresia (EA) is > 90% at present. The purpose of this study was to evaluate early complications and long term outcome in children with EA treated at our institution.

Methods and Patients: Retrospective analysis of 111 children with EA undergoing repair of EA or tracheoesophageal fistula (TEF). Assessment of early and intermediate complications as well as long term morbidity and mortality.

Results: Primary anastomosis was performed in 90 (81%) and secondary anastomosis in 7 patients (6%). Gastric transposition was carried out in 14 children (13%). The postoperative mortality was 14/111 (12.6%) and could be estimated by the Spitz classification. At the age of 10 years, 33 patients (72%) were swallowing without problems, 39 children (85%) were eating at least most of the time with pleasure but 19 children (41%) had a body weight less than the 25^th percentile. Staged repair by gastric transposition resulted in the least amount of motility dysfunction. Long-term respiratory morbidity was high.

Conclusion: The survival of children with EA has improved in the last two decades. For risk assessment the Spitz’ classification is valid. Long term gastrointestinal and respiratory morbidity remains high. In children with long-gap EA gastric transposition performed as a staged procedure has satisfactory results and seems superior to techniques preserving the native esophagus.

Zusammenfassung

Hintergrund: Die Überlebensrate von Kindern mit Ösophagusatresie (ÖA) hat sich in den letzten Jahrzehnten deutlich verbessert und beträgt gegenwärtig >90%.

Methode und Patienten: Retrospektive Analyse von 111 Kindern mit ÖA oder tracheoösophagealer Fistel (TÖF). Erfassung von frühen und intermediären postoperativen Komplikationen sowie von Morbidität und Mortalität im Langzeitverlauf.

Ergebnisse: Bei 90 Kindern (81%) wurde eine primäre und bei 7 Patienten (6%) eine sekundäre Ösophagostomie durchgeführt, bei 14 Kindern (13%) erfolgte die Rekonstruktion der ösophagealen Passage durch gastrische Transposition. Die postoperative Mortalität betrug 14/111 (12,6%) und korrelierte mit der Spitz-Klassifikation. Mit 10 Jahren konnten 33 Kinder (72%) problemlos schlucken, 39 Kinder (85%) aßen meistens gerne und 19 Kinder (41%) hatten ein Körpergewicht unterhalb der 25. Perzentile. Eine zweizeitige Rekonstruktion durch gastrische Transposition ging mit den geringsten Motilitätsstörungen einher. Die respiratorische Morbidität war im Langzeitverlauf hoch.

Schlussfolgerung: Das Überleben von Kindern mit ÖA hat sich in den letzten beiden Dekaden verbessert. Zur präoperativen Risikoeinschätzung hat die Spitz-Klassifikation weiterhin Gültigkeit. Sowohl die gastrointestinale als auch pulmonale Morbidität ist im Langzeitverlauf hoch. Bei langstreckigen ÖA war die zweizeitige gastrische Transposition der Rekonstruktion des nativen Ösophagus überlegen.

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Correspondence

Dr. Martin Lacher

Dr. von Haunersches

Kinderspital

Pediatric Surgical Clinic

Lindwurmstraße 4

80337 München

Germany

Phone: +49/89/5160-7810

Fax: +49/89/5160-7815

Email: martin.lacher@lmu.de