Current results in repair of esophageal atresia with tracheoesophageal fistula using physiologic status as a guide to therapy

Since 1966, 118 infants with esophageal atresia associated with tracheoesophageal atresia (Vogt-Gross Type C) have been operated upon with an overall survival rate of 90% at our institution. Since Haight's first survivor in 1941, argument has continued about the relative merits of immediate rep...

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Bibliographic Details
Published in:Annals of surgery 1989-05, Vol.209 (5), p.526-531
Main Authors: RANDOLPH, J. G, NEWMAN, K. D, ANDERSON, K. D
Format: Article
Language:English
Subjects:
Biological and medical sciences
Birth Weight
Esophageal Atresia - classification
Esophageal Atresia - complications
Esophageal Atresia - surgery
Esophagus
Gastroenterology. Liver. Pancreas. Abdomen
Gastrostomy - adverse effects
Gestational Age
Humans
Infant, Newborn
Malformations
Medical sciences
Postoperative Complications - epidemiology
Prognosis
Time Factors
Tracheoesophageal Fistula - classification
Tracheoesophageal Fistula - complications
Tracheoesophageal Fistula - surgery
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Summary:Since 1966, 118 infants with esophageal atresia associated with tracheoesophageal atresia (Vogt-Gross Type C) have been operated upon with an overall survival rate of 90% at our institution. Since Haight's first survivor in 1941, argument has continued about the relative merits of immediate repair, delayed primary repair, and staged repair, and the criteria for selection of each approach. The Waterston classification served as the foundation for selection of surgical management from 1966 to 1982. Since 1982, physiologic status has been used as the sole basis for surgical management without regard to weight, gestation, or pulmonary condition. Twenty-six patients so chosen for immediate repair have all survived. Fewer have required gastrostomy, and the average hospital stay has shown significant decrease, a reflection of improved overall care of the neonate. Thirteen infants with severe cardiopulmonary compromise had some form of staged repair in this latter period with a 77% survival rate. Our experience using a refinement of Waterston's principles has led to more and earlier primary repairs with maintenance of excellent survival rates in stable infants. A staged approach is still useful for certain severely compromised infants.
ISSN:0003-4932
1528-1140
DOI:10.1097/00000658-198905000-00003