Oesophageal Atresia: Role of Gap Length in Determining the Outcome

Twenty neonates born with oesophageal atresia and tracheoesophageal fistula over a period of two years were managed and the role of gap length between the two ends of oesophagus on the outcome was studied. Twelve (60%) were males and 8 (40%) were females. Body weight ranged from 2.2 kg to 3 kg. Only 2 (10%) were received within 24 hours of birth. Six (30%) were received within 48 hours of birth, 3 (15%) were 3 days old and 9 (45%) were ≥ 6 days old at the time of admission. Gap between the upper pouch and the lower fistulous end of oesophagus was ≤ 2cm in 4 (20%), >2cm but ≤ 3cm in 8 cases (40%) and >3 cm in 8 (40%) cases. Preoperatively chest infection was found in 16 (80%) cases. Associated congenital malformations were found in 7 (35%) cases. Primary anastomsis of Oesophagus was performed in all the cases. In order to relieve the tension on the anastomosis upper segment circular myotomy was performed in 8 (40%) cases. Post operative survival was 45%. Early postoperative complications among survivors included anastomotic leak in 3 (33%), pneumonia in 2 (22%) and wound infection in 2 (22%) cases. Late complications included gastroesophageal reflux in 7 (78%) and stricture formation in 6 (67%) cases. Major cause of death was sepsis secondary to chest infection. Authors conclude that prognosis of oesophageal atresia-tracheoesophageal fistula is excellent in children born with gap length ≤ 2cm. Morbidity and mortality increases proportionately as gap length increases beyond 2 cm.