Mortality and Short Term Morbidity of Infants with Long-gap Esophageal Atresia

Overview

Aim of study:
Analysis of mortality and morbidity of infants with long-gap esophageal atresia treated during1992 to 2001.Methods: Retrospective analysis of hospital charts of patients.Results: 109 infants with esophageal atresia were operated on, 34 of them having long-gap (LG) esophagealatresia. Compared to infants with normal distance of esophageal stumps (non-LG), those with LG had significantlylower birth weight (2238 g vs. 2606 g), lower gestational age (36.2 vs. 38 weeks) and higher occurrence of imperforateanus (26.5 vs. 10.7%) and duodenal atresia (17.3 vs. 4%). In the LG group the incidence of anastomotic leak was20.6%, stricture 26.5% and septic complications 64.7%. The incidence of gastroesophageal reflux was higher innon LG patients (33.5%) than in LG (23.5%). The LG patients were ventilated (25.2 vs. 13.8 days) and hospitalized(110.3 vs. 42.9 days) longer. Ten (29.4%) patients with LG died. All of them were from the group of 20 patientswith delayed anastomosis performed or planned. The most frequent cause of deathwas sepsis. There were no deathsin the groups with primary anastomosis or esophageal substitution (7 infants each).Conclusions: Long-gap between esophageal stumps is a negative prognostic factor in the studied group. Anattempt at higher proportion of primary anastomoses and shorter interval of waiting for stumps prolongationbefore delayed anastomosis might decrease the length of necessary intensive care support and septic complicationsthat were the principal cause of death in our series.

Key words:
long-gap esophageal atresia, esophageal substitution, primary anastomosis, leak stricture, gastroesophagealreflux, mortality