Abstract
Oesophageal atresia management has evolved alongside the development of paediatric surgery. An analysis of a 30-year prospective collection of oesophageal atresia cases treated at the Royal Alexandra Hospital for Children, NSW, Australia is presented. There has been a dramatic change in the surgical approach. Fewer infants are undergoing operations of cervical oesophagostomy, gastrostomy and oesophageal replacement. More, including fragile infants, are surviving with a repaired native oesophagus. Fewer infants are suffering morbidity secondary to anastomotic leak. The progression in treatment has been enabled by improved neonatal support due to advances in neonatology, neonatal anaesthesia, nutritional support and antimicrobial therapy. Oesophageal atresia treatment and outcome has changed markedly over three decades. Cooperative multi-centre database development is now required to provide data in order to further refine treatment for clinical challenges that remain.
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References
Myers NA (1992) Oesophageal atresia. Pediatr Surg Int 7:83–85
Weber TR, Smith W, Grosfeld JL (1980) Surgical experience in infants with the VATER association. J Pediatr Surg 15:849–854
Rokitansky AM, Kolankaya VA, Seidl S (1993) Recent evaluation of prognostic risk factors in esophageal atresia—a multicentre review of 223 cases. Eur J Pediatr Surg 3:196–201
Spitz L, Kiely E, Brereton RJ Drake D (1993) Management of esophageal atresia. World J Surg 17:296–300
Spitz L, Kiely EM, Morecroft JA, Drake DP (1994) Oesophageal atresia: at-risk groups for the 1990s. J Pediatr Surg 29:723–725
Rowe MI, Rowe SA (2000) The last fifty years of neonatal surgical management. Am J Surg 180:345–352
Lancaster P, Day P, Huang J, Shafir E (1997) Oesophageal atresia or stenosis. In: Congenital malformations Australia 1993 and 1994. AIHW National Perinatal Statistics Unit, Sydney, pp 70–71
Myers NA (1991) Oesophageal atresia. In: Beasley S, Myers NA, Auldist AW (eds) Oesophageal atresia. Chapman Hall, London
Myers NA (1986) The history of oesophageal atresia and tracheo-oesophageal fistula—1670–1984. Prog Pediatr Surg 20:106–157
Benjamin B (1981) Endoscopy in esophageal atresia and tracheoesophageal fistula. Ann Otol Rhinol Laryngol 90:376–382
Keily E, Spitz L (1987) Is routine gastrostomy necessary in the management of oesophageal atresia. Pediatr Surg Int 2:6–9
Beasley SW, Myers NA (1992) Trends in mortality in oesophageal atresia. Pediatr Surg Int 7:86–89
Poenaru D, Laberge JM, Neilson IR, Guttman FM (1993) A new prognostic classification for esophageal atresia. Surgery 113:426–432
Hands LJ, Dudley NE (1986) A comparison between gap-length and Waterston classification as guides to mortality and morbidity after surgery for esophageal atresia. J Pediatr Surg 21:404–406
Louhimo I, Lindahl H (1983) Esophageal atresia: primary results of 500 consecutively treated patients. J Pediatr Surg 18:217–229
Beasley SW (1991) Influence of anatomy and physiology on the management of oesophageal atresia. Prog Pediatr Surg 27:53–61
Holmes SJK, Keiley EM, Spitz L (1987) Tracheo-oesophageal fistula and the respiratory distress syndrome. Pediatr Surg Int 2:16–18
Chahine AA, Ricketts RR (2000) Esophageal atresia in infants with very low birth weight. Semin Pediatr Surg 9:73–78
Sharma AK, Shekhawat NS, Agrawal LD, Chaturvedi V, Kothari SK, Goel D (2000) Esophageal atresia and tracheoesophageal fistula: a review of 25 years experience. Pediatr Surg Int 16:478–482
Beasley SW, Auldist AW (1991) Oesophageal atresia with distal tracheo-oesphageal fistula. In: Beasley S, Myers NA, Auldist AW (eds) Oesophageal atresia. Chapman Hall, London, pp 119–135
Donn SM, Zak LK, Bozynski ME, Coran AG, Oldham KT (1990) Use of high-frequency jet ventilation in the management of congenital tracheoesophageal fistula associated with respiratory distress syndrome. J Pediatr Surg 25:1219–1221
Jones JB, Kirchner SG, Lee FA, Heller RM (1980) Stomach rupture associated with esophageal atresia, tracheoesophageal fistula, and ventilatory assistance. AJR Am J Roentgenol 134:675–677
Maoate K, Myers NA, BeasleySW (1999) Gastric perforation in infants with oesophageal atresia and distal tracheo-oesophageal fistula. Pediatr Surg Int 15:24–27
Saing H, Mya GH, Cheng W (1998) The involvement of two or more systems and the severity of associated anomalies significantly influence mortality in esophageal atresia. J Pediatr Surg 33:1596–1598
Driver CP, Shankar KR, Jones MO, Lamont GA, Turnock RR, Lloyd DA, Losty PD (1999) Contemporary management and outcome of oesophageal atresia in the Spitz classification era. BAPS, London
Alexander F, Johanningman J, Martin LW (1993) Staged repair improves outcome of high-risk premature infants with esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 28:151–154
Randolph JG, Newman KD, Anderson KD (1989) Current results in repair of esophageal atresia with tracheoesophageal fistula using physiologic status as a guide to therapy. Ann Surg 209:526–530
Spitz L (1993) Esophageal atresia and tracheoesophageal fistula in children. Curr Opin Pediatr 5:347–352
Scharli AF (1992) Esophageal reconstruction in very long atresias by elongation of the lesser curvature. Pediatr Surg Int 7:101–105
Kimura K, Soper RT (1994) Multistaged extrathoracic esophageal elongation for long gap esophageal atresia. J Pediatr Surg 29:566–568
Kimura K, Soper RT (2001) Multistaged extrathoracic esophageal elongation procedure for long gap esophageal atresia: experience with 12 patients. J Pediatr Surg 36:1725–1727
Keily E, Spitz L, Brereton R (1987) Management of tracheomalacia by aortopexy. Pediatr Surg Int 2:13–15
Canty TG, Boyle EM, Linden B (1997) Aortic arch anomalies associated with long gap esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 32:1587–1591
Cozzi F, Morini F, Casati A, Camanni D, Zani A, Cozzi DA (2002) Glossopexy as an alternative to aortopexy in infants with repaired oesophageal atresia and upper airway obstruction. J Pediatr Surg 37:202–206
Nelson SP, Chen EH, Syniar GM, Christoffel KK (1997) Prevalence of symptoms of gastroesophageal reflux during infancy. A pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med 151:569–572
Jolley SG, Tunell WP, Hoelzer DJ, Thomas S, Smith EI (1986) Lower esophageal pressure changes with tube gastrostomy: a causative factor of gastroesophageal reflux in children? J Pediatric Surgery, 1986. 21:624–627
Kirkpatrick J, Cresson S, Pilling G (1961) The motor activity of the esophagus in association with esophageal atresia and tracheoesophageal fistula. AJR Am J Roentgenol, Radium Therapy & Nuclear Medicine 86:884–887
Romeo C, Bonanno N, Baldari S (2000) Gastric motility disorders in patients operated on for esophageal atresia and tracheoesophageal fistula: long-term evaluation. J Pediatr Surg 35:740–744
Csendes A, Oster M, Moller J, Brandsborg O, Brandsborg M, Amdrup E (1979) The effect of extrinisic denervation of the lower part of the esophagus on resting and cholinergic stimulated gastroesophageal sphincter in man. Surg Gynecol Obstet 148:375–379
Davies MR (1996) Anatomy of the extrinsic motor nerve supply to mobilized segments of the oesophagus disrupted by dissection during repair of oesophageal atresia with distal fistula. Br J Surg 83:1268–1270
Qi BQ, Merei J, Farmer P, Hasthorpe S, Myers NA, Beasley SW, Hutson JM (1997) The vagus and recurrent laryngeal nerves in the rodent experimental model of esophageal atresia. J Pediatr Surg32:1580–1586
Qi BQ, Merei J, Myers N, Beasley SW, Hutson JM (1997) Effect of esophageal atresia on the vagus and recurrent laryngeal nerves in the rodent experimental model. AAPS
Cheng W, Bishop AE, Spitz L, Polak JM (1999) Abnormal enteric nerve morphology in atretic esophagus of fetal rats with adriamycin-induced esophageal atresia. Pediatr Surg Int15:8–10
Cheng W, Spitz L, Milla P (1997) Surface electrogastrography in children with esophageal atresia. Pediatr Surg International 12:552–555
Montgomery M, Escobar-Billing R, Hellstrom PM, Karlsson KA, Frenckner B (1998) Impaired gastric emptying in children with repaired esophageal atresia: a controlled study. J Pediatr Surg33:476–480
McKinnon LJ, Kosloske AM (1990) Prediction and prevention of anastomotic complications of esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 25:778–781
Leendertse-Verloop K, Tibboel D, Hazebroek FWJ, Molenaar JC (1987) Postoperative morbidity in-patients with esophageal atresia. Pediatr Surg Int 2:2–5
Teng AY, Mitchell J, Morton J, Shi E (1996) Outcome of children with oesophageal atresia and tracheo-oesophageal fistula: gastro-oesophageal reflux and respiratory function. N.S.W. Paediatrics Conference, 1996
Robert E, Mutchinick O, Mastroiacovo P, Knudsen LB, Daltveit AK,Castilla EE (1993) An international collaborative study of the epidemiology of esophageal atresia or stenosis. Reprod Toxicol 7:405–421
Acknowledgments
The senior author initiated this comparative study for the purpose of a presentation at a surgical meeting held to honour Fred Leditschke upon his retirement. Guy Henry and Kiut Lu are acknowledged for their contribution to the oesophageal atresia database.
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Orford, J., Cass, D.T. & Glasson, M.J. Advances in the treatment of oesophageal atresia over three decades: the 1970s and the 1990s. Ped Surgery Int 20, 402–407 (2004). https://doi.org/10.1007/s00383-004-1163-1
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DOI: https://doi.org/10.1007/s00383-004-1163-1