Abstract
A prospective trial was undertaken to assess the need for routine gastrostomy in the management of the infant with oesophageal atresia. Over a 34-month period, 51 infants with oesophageal atresia and distal tracheo-oesophageal fistula were assigned to either gastrostomy or transanastomotic tube group. The two groups were similar in terms of birth weight, gestational age, risk group, associated anomalies, and anastomotic tension. There was no difference in the number of anastomotic leaks or strictures. The incidence of significant gastro-oesophageal reflux was 72% (n=18) in the gastrostomy group compared with 30% (n=8) in the transanastomotic tube group. forty-four per cent (n=10) of the former required antireflux surgery compared with 15% (n=4) in the latter group. The conclusion was that routine gastrostomy is unnecessary in the management of infants with oesophageal atresia and may be positively harmful in promoting gastro-oesophageal reflux.
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References
Bishop PJ, Klein MD, Phillipart AI, Hixson DS, Hertzler JH (1985) Transpleural repair of esophageal atresia without primary gastrostomy: 240 patients treated between 1951–1983. J Pediatr Surg 20: 823–828
Campbell JR, Sasaki TM (1974) Gastrostomy in infants and children. An analysis of complications and techniques. Am Surg 9: 505–508
Connar RG, Sealy WC (1956) Gastrostomy and its complications. Ann Surg 143: 245–250
de Lorimier AA, Harrison MR (1985) Esophageal atresia: embryogenesis and management. World J Surg 9: 250–257
Grosfeld JL, Ballantine TV (1978) Esophageal atresia and tracheoesphageal fistula: effect of delayed thoracotomy on survival. Surgery 84: 394–402
Holder TM (1986) Esophageal atresia and tracheoesophageal fistula. In: Ashcraft KW, Holder TM (eds) Pediatric Surgery. Grune and Stratton, New York, pp 29–52
Koop CE, Schnauffer L, Broenner AM (1974) Esophageal atresia and tracheoesophageal fistula. Supportive measures that affect survival. Pediatrics 54: 558–564
Kraeft H, Roos R, Ring- Mrozik E (1986) Gastrostomy and gastric colonization. Impact on neonatal septicemia. Pediatr Surg Int 1: 125–129
Louhimo I, Lindahl H (1983) Esophageal atresia: primary results of 500 consecutively treated patients. J Pediatr Surg 18: 217–229
Martin LW, Alexander F (1985) Esophageal atresia. Surg Clin North Am 65: 1099–1113
Myers NA (1979) Oesophageal atresia and/or tracheooesophageal fistula: a study of mortality. Progr Pediatr Surg 13: 141–165
O'Neill JA, Holcolm GW, Neblett WW (1982) Recent experience with esophageal atresia. Ann Surg 195: 739–745
Randolph JG, Altman RP, Anderson KD (1977) Selective surgical management based on clinical status in infants with esophageal atresia. J Thorac Cardiovasc Surg 74: 335–342
Tunell WP, Jolley SG, Hoelzer DJ, Thomas S, Smith E Ide (1986) Lower esophageal pressure changes with tube gastrostomy: a causative factor of gastroesophageal reflux in children. J Pediatr Surg 21: 624–627
Waterston DJ, Bonham Carter RE, Aberdeen E (1962) Oesophageal atresia: tracheooesophageal fistula. A study of survival in 218 infants. Lancet I: 819–822
Wilkins BM, Spitz L (1986) Incidence of postoperative adhesion obstruction following neonatal laparotomy. Br J Surg 73: 762–764
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Kiely, E., Spitz, L. Is routine gastrostomy necessary in the management of oesophageal atresia?. Pediatr Surg Int 2, 6–9 (1987). https://doi.org/10.1007/BF00173596
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DOI: https://doi.org/10.1007/BF00173596