Feeding troubles following delayed primary repair of esophageal atresia

Severe feeding troubles were recorded in five babies with long-gap esophageal atresia who underwent, between 1985 and 1990, a delayed primary anastomosis after spontaneous growth of their esophageal stumps. A comparison with 20 cases of direct esophageal anastomosis, operated on in the same period, was carried out by means of recorded esophagrams, pH monitoring and questionnaires charting the growth pattern and feeding habits of the patients. Bottle feeding, and, later on, the introduction of semi-solid foods was significantly retarded in the group of children with delayed primary anastomosis (labeled as group B) as well as height and weight parameters. Failure to complete feeds, dysphagia, vomiting, coughing, choking and recurrent respiratory symptoms were also significantly more common in this group than in the primary anastomosis group (labeled as group A) even in the absence of stricture. Variable degrees of disordered esophageal motility were present in all patients but pooling of the contrast medium, retrograde flow and delayed clearing of the esophagus were more frequent in group B. No patient was shown to have associated hiatal hernia. A 24 hour pH recording showed severe gastroesophageal reflux in 4 out of 13 cases of group A and in 3 out of 5 cases of group B. Clearing times were significantly delayed in all refluxing children. Our data suggest that the retarded start of oral feeding and swallowing coordination in patients with delayed primary anastomosis add further negative factors to their congenitally impaired esophageal motility, causing protracted dysphagia which represents a major problem for both family and hospital staff. Bei 5 Neugeborenen mit einer Osophagusatresie mit langer Distanz und verzogerter Primaranastomose wurden erhebliche Ernahrungsschwierigkeiten beobachtet. Bei einer Vergleichsgruppe an 20 im gleichen Zeitraum operierten Sauglingen mit primarer Osophagusanastomose traten diese Probleme in weitaus geringerem Mase auf. Bei allen Patienten wurde auf die individuelle klinische Symptomatik geachtet und sowohl ein Osophagogramm wie eine pH-Metrie durchgefuhrt. Bei allen Patienten fanden sich Motilitatsstorungen unterschiedlicher Auspragung; aber zeitlich verzogerte Mahlzeiten, Dysphagie, Erbrechen, Husten, Rezidivinfektionen der oberen Luftwege, Jo-jo-Phanomen, retrograder Kontrastmittelflus und verzogerte Osophagusclearance waren bei den Patienten mit verzogerter primarer Anastomose haufiger. Kein Patient hatte eine Hiatushernie, aber 4 von 13 primar anastomosierten und 36 von 5 verzogert operierten Kindern zeigten einen schweren gastroosophagealen Reflux mit verzogerter Osophagusclearance. Eine verzogerte Osophagusanastomose bei Osophagusatresie mit langer Distanz schafft daher aufgrund verschiedener Faktoren zusatzliche Ernahrungsprobleme.