ESOPHAGEAL ATRESIA: RESULTS OF 108 CASES IN AN 11 YEAR PERIOD

From October 1977 to December 1988, 108 neonates born with esophageal atresia (EA) and/or a tracheoesophageal fistula (TEF) were treated at the Bristol Royal Hospital for Sick Children. An incidence of I :4000-4500 live births was noted. 1I2.4% had the common- type anomaly, 5.5% had pure esophageal atresia, and 6.5% had an H-type anomaly. 2.8% had upper and lower fistulae and 2.8% had upper fistulae. Forty-nine patients (45.3%) had associated anomalies of which the cardiovascular system (16.6%) was the most commom. With consideration of the urogenital system as a unique system, urogenital anomalies were the most common associated anomalies (20.3%). Thirty (27.7%) of lOll neonates had V ACTERL associated anomalies, which were more frequent in the common- type anomaly. Seven of 9 deaths in the VACTERL associated group were because of associated anomalies and cardiac anomalies were a common cause of late death in this study. In full-term and well babies with common-type anomalies, transanastomotic tubes significantly decreased hospital stay. Every effort was made to maintain the neonate's own esophagus, and in pure esophageal atresia 5 of 6 neonates were successfully treated by spontaneous growth and anastomosis and only I neonate underwent gastric- tube formation as an esophageal replacement. Anastomosis was done in one layer by 5/0 silk , and 17.14% developed leak, 29.62% strictures, 1.90% recurrent fistula, and the rate of anastomotic complications was markedly higher in delayed and staged operations. Fifty-three neonates (50.47%) had respiratory complications which were the most common complication. Thirty-three (31.4%) had gastroesophageal reflux (GER), all but one of which were treated medically. The routine policy now is that all babies are put on Gaviscon until the child can adopt an upright position. Low birth weight and pneumonia are not contraindications for surgery, and with the improvement of surgical technique and postoperative care, do not affect survival. There was 12.03% mortality and the main cause of death was associated anomalies.