Esophageal Atresia And Tracheoesophageal Fistula: Experience From A Pediatric Tertiary Care Institute

Aim The purpose of this study is to survey the clinicopathological factors of esophageal atresia with or without tracheoesophageal fistula (EA +-TEF) cases in order to appraise additional perioperative factors affecting the surgical outcome of these cases. Materials & Methods We carried out a retrospective scrutinization of 34 neonates with EA +-TEF over a period of five years. Patients’ demographics, age at presentation, associated anomalies, hematological, biochemical and radiological data, intraoperative findings, perioperative Neonatal Intensive Care Unit (NICU) care records and outcomes were collected and analysed. Results 32 neonates had EA with a distal TEF (type C) who underwent primary esophageal anastomosis. Two had pure EA (type A) with long gap where cervical esophagostomy and feeding gastrostomy were undertaken. 17 cases (50%) were diagnosed 72 hours after birth and referred from rural hospital where no / inadequate NICU backup was present. 40% of cases needed ionotropic support and ventilatory support for preoperative stabilization. There was 18 (52.94%) death in this series. 90% of total death occurred in neonates who were admitted 5 days after birth and required prolonged Post Operative Ventilation (POV) support. The causes of death were preoperative pneumonitis, Acute Respiratory Distress Syndrome (ARDS) and Ventilator Associated Pneumonia (VAP). Conclusion In developing countries, late presentation and prolonged POV have calamitous effects to the surgical outcome of EA +-TEF.