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Improved Outcome in Management of Oesophageal Atresia with or without Tracheo-Oesophagial Fistula (Abstract)

Gamal Al-Saied¹ and Ali Alzhrani²

¹Department of Pediatric Surgery - Al-Azhar University, Cairo, Egypt

²Department of Neonatal Intensive Care Unit (NICU)

¹,²King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia.

 

Abstract

Background: Oesophageal Atresia (OA) with or without Tracheo-Oesophageal Fistula (TOF) is a rare congenital anomaly. The survival rate of infants with OA with or without TOF has improved over the past few decades. The aim of this study was to critically review our surgical experience of the last 5 years to evaluate the outcome in management of OA with or without TOF in our region in comparison with the international results.

Patients and Methods: This work was carried out at King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia in the period from December 2001 through December 2006. The period of follow up was 50 months on average. Thirty two neonates (21 males and 11 females) diagnosed as OA with or without TOF. After stabilization, 27 cases were treated by oesophago-oesophageal anastomosis via posterolateral thoracotomy, extrapleural approach, 5 cases were treated by staged procedure (ligation of fistula, cervical oesophagostomy and feeding gastrostomy) due to long gap oesophageal atresia and marked prematurity. The other 4 extremely low birth weight babies passed away 4-6h after birth due to cardiopulmonary failure.

Results: 11 (34.38%) cases developed gastro-oesophageal reflux, 2 cases (6.25%) developed minimal leakage postoperatively which healed spontaneously by conservative treatment,6(18.75%) cases developed pneumonia, 3 cases (9.38%) developed stricture resolved by regular balloon dilatation. Death has occurred in 2(6.25%) cases postoperatively and 4 (12.50%) cases before definitive surgery due to severe sepsis and cardiopulmonary failure. There was no single case of fistula recurrence or redo. Our survival rate in comparison with the published international survival rates using Waterston, Spitz and Bremen prognostic classification are summarized in tables (3,4 and5) respectively.

Conclusion: On the basis of this critical retrospective review of our surgical experience over the last 5 years, our results are comparable with the published international survival rate. We believe that the advances in neonatal intensive care, pediatric anesthesia, and refinements in surgical techniques have contributed to improve outcomes of oesophageal atresia.

Key words: Oesophageal Atresia , Tracheo-Oesophageal Fistula

 

 

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