Management of patients with esophageal artesia with or without tracheoesophageal fistula, a 7 years experience

Abstract

Objective: To see the short term outcome in patients treated for esophageal artesia with or without tracheo-esophageal fistula in our setup. Design: Descriptive and retrospective. Place and Duration: Department of Paediatric Surgery & Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from January 1998 to December 2004 with duration of 7 years. Materials and Methods: After diagnosis, patients were put on broad-spectrum intravenous antibiotics, intravenous fluids, vitamin K injection and throat suction in a normothermic environment. Diagnosis was established mainly on clinical grounds and supported by passing a big size nasogastric suction tube (size 10 Fr) through the mouth into the esophagus and taking a plain X-ray chest of the patient. After adequate preparation, through a right thoracotomy in 5th intercostals space, fistula repair and esophageal anastomosis was performed extrapleurally in patients with tracheoesophageal fistula while gastrostomy and ce rvical esophagostomy was performed in patients with pure esophageal atresia. Transanastomotic tube was passed as a nasogastric tube size 10 to act as a stent and later on used for tube feeding. Results: A total of 60 patients with esophageal artesia with or without tracheoesophageal fist ula were admitted. There were 40 males and 20 females. Age ranged from 1-7 days. Weight of the newborn patients was in the range of 2 - 3Kg. Four patients had cyanotic congenital heart disease, two were with imperforate anus and two with spina bifida. All patients had some form of bronchopneumonia due to aspiration of upper pouch contents out of whom 30 patients had severe pneumonia. Six patients left the hospital against medical advice and 6 patients died before operation. Forty-eight patients were operated. Esophagostomy and astrostomy was performed for pure esophageal atresia (10 Patients), while in 38 patients, a right thoracotomy in the 5" inter costal space with fistula ligation & esophageal anastomosis was performed. Three out of ten patients with pure esophageal atresia died, while eighteen patients with tracheoesophageal fistula died after surgery. Twenty-seven out of total 48 patients survived and were discharged to home after an average hospital stay of 7 days after surgery. Eleven patients were s een in follow up and treated accordingly. Conclusion: This study shows that majority of these patients presented late because of improper referral system.