Esophageal atresia/tracheoesophageal fistula in very low-birth-weight neonates: improved outcomes with staged repair

Mikael Petrosyan, Joaquin Estrada, Catherine Hunter, Russell Woo, James Stein, Henri R. Ford, Dean M. Anselmo

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

Introduction: The surgical management of esophageal atresia with distal tracheoesophageal fistula (EA/TEF) involves early division of the TEF and primary esophageal anastomosis. However, in premature infants, the morbidity associated with primary repair remains high, and the optimal surgical approach has not been well defined. Methods: Medical records of very low-birth-weight infants (<1500 g) with EA/TEF from June 1987 to 2008 were retrospectively reviewed. Patients were separated into 2 groups: (1) primary repair and (2) ligation and division of TEF followed by delayed repair of EA. Demographics, anastomotic, and postoperative complications were compared. Results: Twenty-five premature infants with EA/TEF were identified. Sixteen patients (64%) underwent primary repair, and 9 (36%) were repaired in a staged manner. The leak rate confirmed by esophagram was significantly higher after primary repair (50%) compared to staged repair (0%) (P = .034). Strictures occurred significantly more often in the primary repair (81%) vs the staged repair (33%) group (P = .036). Postoperative pneumonia and sepsis were significantly higher in patients treated with primary repair (P = .028). Conclusion: Staged repair of EA/TEF in very low-birth-weight premature infants results in a significantly lower rate of anastomotic complications and overall morbidity and should be considered the preferred surgical approach in this group of patients.

Original languageEnglish (US)
Pages (from-to)2278-2281
Number of pages4
JournalJournal of Pediatric Surgery
Volume44
Issue number12
DOIs
StatePublished - Dec 1 2009
Externally publishedYes

Keywords

  • Esophageal atresia
  • Premature infants
  • Staged repair
  • Very low-birth-weight infants

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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