Ten Years of Management of Esophageal Atresia in Benin: State of the Art, Experiences and Needs for Families of Children with Stoma

Abstract

Background/Purpose: Esophageal atresia (EA) is a congenital defect in the thoracic esophagus associated or not with a tracheoesophageal fistula (TEF). It is associated with high mortality in low-income countries such as Burkina Faso, Madagascar and Ghana. The purpose of this study was to present the recent management of newborns with EA/TEF in Benin and to identify the needs of families whose children have survived. Method: Over a period of 10 years, 54 newborns with EA/TEF operated on in the 2 largest university hospitals in Benin were included. Two groups were identified. Group A (n=33) included newborns in whom a primary repair had been performed. Group B (n=21) involved newborns who underwent staged repair. Staged repair involved cervical oesophagostomy + gastrostomy (n= 7) or upper oesophageal pouch suction + gastrostomy (n=2) or cervical esophagostomy + stoma of the lower esophageal pouch (n=12). Ten parents from group B were interviewed for the needs survey. The significance level was defined as p < 0.05. Results: There were 31 male newborns. The median for gestational age was 37 gestational weeks (range: 35 - 38). Polyhydramnios was observed in 4 cases. The mean birth weight was 2365 g. (range: 1000 g - 3500 g). The mean age at diagnosis was 3.48 days (range: 24 hours - 19 days). Surgery was performed at day 5 on average with extremes from day 2 to day 17. The surgery lasted an average of 2h12 min and the overall mortality rate was 74.07%. Mortality rate in group A was 100% and 33.33% in group B. There was a strong statistically significant difference in survival between the two groups. (p=19.10-8). Sepsis was the most common cause of death. Stress, fear and anxiety of losing the child were the difficulties frequently encountered at bedtime and every day. Four parents had to stop their activities to be available to take care of their child. All the parents had expressed the need for psychological support. Conclusion: Pending an improvement of the technical platform, staged repair remains an essential option for the survival of patients. The creation of a framework for discussion with families authorizing social actions and quality medical support is desired.