Results of Patients Operated on for Long Gap Esophageal Atresia: 5-Year Follow up

Abstract

Background: Esophageal atresia and tracheoesophageal fistula are rare congenital anomalies. Among these, long gap atresia is scarcely seen and primary anastomosis could not be done. Many operative procedures were designed for these patients, none is ideal method. Postoperative sequelaes are common. Factors that should be concerned for management plan include difficulty of procedures, outcomes that effected on quality of life for the patients and their families.

Objectives: The aims of this report were to evaluate the long term results of each patient, operated on with different procedures and to introduce the technique designed to correct postoperative complications.

Patients and Methods: Eight patients with long gap esophageal atresia were treated at Maharat Nakhon Ratchasima hospital during 1993 and 2002, three patients were operated with Livaditis’s operation, one gastric tube conduit and four colon interposition. Length of follow up was 5 to 7 years. The results were evaluated by interviewing and medical record studying focused on respiratory and gastrointestinal problems, quality of life in psychosocial and home health care. The outcomes were grouped into 3 categories: good, moderate and poor, scoring by severity of respiratory, gastrointestinal symptom and quality of life.

Results: All patients became normal life within 5 years post operation, Significant gastrointestinal symptoms in colon interposition group are dysphagia, regurgitation, vomiting and diarrhea. Useful technique for postoperative dilatation was to guide with nylon left in esophagus and stomach. Same sequelaes were found among Livaditis group, critically by 2 years post operation due to pathology and kinds of food intake. Only one patient operated by gastric tube conduit suffered with the same sequelaes, added with pressure symptoms. Respiratory problems presented in all patients; bronchitis and pneumonia, hospitalization was needed in the first year. Other symptoms were cough and short breath. Their quality of life are accepatable and became normal within 5 years.

Conclusion: Management for long gap atresia is challenging. Long term evaluation showed that good planning and optimal procedure resulted in excellent outcome.