Strategies for optimizing surgical outcome in patients with esophageal atresia with tracheo-esophageal fistula

Abstract

Background: There have been major advances in the surgery for esophageal atresia (EA) and tracheo-esophageal fistula (TEF) with survival now exceeding 90%. The standard open approach to EA and distal TEF has been well described and essentially unchanged in last 60 years. Improved survival in recent decades is most attributable to advances in neonatal surgical techniques, anaesthesia and perioperative care. In a prospective randomized trial, we analysed the effect of pleural flap wrap around the anastomosis and post-operative elective ventilation support for 48 hours as main strategies towards improving the outcome in such patients.Methods: Twenty five neonates who were diagnosed as a case on tracheo-esophageal fistula (TEF) on clinical and radiological basis were selected for the study. All babies were more than 2kg weight and were operated within first two days of life after optimization. There was no evidence of any congenital heart disease or any other associated anomaly. In all patients primary esophageal anastomosis was possible which was subsequently covered by pleural flap wrap. All the patients were put post-operatively on ventilator electively for 48 hours. Contrast study was done on post-operative day five and feeding was started subsequently.Results: Postoperative surgical outcome was very good. Out of twenty five cases, 24 patients survived and only one baby died secondary to anastomotic leak and sepsis. Twenty three babies were discharged on post-operative day 8. One baby was on ventilator for 6 days and discharged on postoperative day 15. All patients are on regular follow up.Conclusions: Surgical outcome in patients with esophageal atresia and tracheo-esophageal fistula in neonates can be improved with use of pleural flap wrap and elective post-operative ventilation.