Oesophageal Atresia: Clinical Outcome After Surgical Treatment

Author(s): Melanie Kapapa, Daniela Weber, Alexandre Serra.

Background: To evaluate the clinical outcome of oesophageal atresia (OA) after surgical treatment we performed a retrospective study with a controlled observational design.

Materials and Methods: Data were collected from hospital records, questionnaires and additional interviews with families for all OA children treated at our hospital between 2004 and 2015.

Results: Due to a higher incidence of preterm births, OA children showed lower birth weight (p<0.001), worse post-natal adaption (p<0.001) and frequently higher incidence of concomitant diseases (p<0.001) and malformations (p=0.005) like VACTERL (p=0.006) in comparison with normal controls. The surgical correction was performed primarily in 77.4% of the patients, while 9.7% were submitted to a secondary anastomosis. A contrast oesophagogram was performed routinely in most patients, showing an anastomotic leakage in 26.3% of those (more often in preterm, p=0.044) unrelated to moderate or severe documented anastomotic tension (p=0.071). An association with the use of chest drains and trans- anastomotic gastric tubes on postsurgical oesophageal stenosis could not be excluded. As for the clinical outcome, there was a gastroesophageal reflux in 78.9% and stenosis in 73.3% of the patients, leading to feeding problems and the necessity of multiple dilations and gastric acid suppression, respectively.

Conclusion: These clinical outcomes are difficult to compare due to the lack of national- and international consensus in the management of OA children. The restructuring of medical training and the practical implementation of the distribution of various congenital malformations in the sense of priority care to selected centres in the state is decisive for future-oriented paediatric surgical care.