Abstract
The aim of the study was to evaluate the outcome of primary repair of oesophageal atresia (OA)/tracheo-oesophageal (TOF) using an anterior flap from the upper pouch to relieve tension on the anastomosis. Of 66 patients with OA/TOF managed in this institution in the period 1977–1993, only 1 (1.5%) had a colonic interposition. There were 15 (10 long-gap OA) primary repairs with an anterior flap. Median follow-up was 2 years (range 11 months – 16 years). Complications included anastomotic leaks in 4 (27%), anastomotic strictures in 13 (87%), of which 2 (13.3%) required resection, gastro-oesophageal reflux in 9 (60%), of which 3 (20%) required fundoplication, recurrent TOF in 2 (14%), and oesophageal incoordination in 6 (40%). Median hospital stay was 77 days (range 18–240 days). There were 3 late deaths (12, 12, 14 months). Of 12 survivors, 8 (66.7%) achieved normal growth. In addition, 3 patients had a myotomy as well as a flap (anastomotic leak 2, stricture 3). We conclude that the anterior flap technique for repair of OA/TOF reduces the need for oesophageal replacement. There is considerable morbidity associated with its use in these high-risk patients, but a satisfactory outcome can be achieved in long-term survivors.
Similar content being viewed by others
References
Alexander F, Johanningman J, Martin LW (1993) Staged repair improves outcome of high risk premature with oesophageal atresia and tracheoesophageal fistula. J Pediatr Surg 28: 151–154
Azar H, Chrispin AR, Waterstib DJ (1971) Esophageal replacement with transverse colon in infants and children. J Pediatr Surg 6: 3–9
Brown S, Nixon HH (1983) Spontanous anastomosis of the esophagus in esophageal atresia. J Pediatr Surg 18: 293–295
Campbell JR, Webber BR, Harrison MW, et al (1982) Esophageal replacement in infants and children by colon interposition. Am J Surg 144: 29
Cusick EL, Batchelor AAG, Spicer RD (1993) Development of a technique for jejunal interposition in long gap esophageal atresia. J Pediatr Surg 28: 990–994
Davenport M, Bianchi A (1990) Early experience with esophageal flap esophagoplasty for repair of esophageal atresia. Pediatr Surg Int 5: 332–335
De La Hunt MN, Fleet MS, Wagget J (1994) Delayed primary anastomosis for wide-defect esophageal atresia: a 17-year experience. Pediatr Surg Int 9: 21–23
Ein SH, Shandling B, Simpson J, Stephens CA (1973) A further look at the gastric tube as an esophageal replacement in infants and children. J Pediatr Surg 8: 859–867
Ein SH, Shandling B, Stephens CA (1987) Twenty one year experience with the pediatric gastric tube. J Pediatr Surg 22: 77–81
Gough MH (1980) Esophageal atresia — use of an anterior flap in the difficult anastomosis. J Pediatr Surg 15: 310
Haller JA Jr, Brooker AF, Talbert JL, et al (1966) Esophageal function following resection studies in new born puppies. Ann Thorac Surg 2: 180–187
Hendren WH, Hale JR (1976) Esophageal atresia treated by electromagnetic bougienage and subsequent repair. J Pediatr Surg 11: 713–722
Howard R, Myers NA (1965) Esophageal atresia: a technique for elongating the upper pouch. Surgery 58: 725–727
Janik J, Filler RM, Ein SH, Simpson JS (1980) Long-term follow up of circular myotomy for esophageal atresia. J Pediatr Surg 15: 835–841
Linahl H, Louhimo Z, Virkola K (1983) Colon interposition or gastric tube? Follow up study of colon-esophagus and gastric tube-esophagus patients. J Pediatr Surg 18: 58–63
Livaditis A (1793) Esophageal atresia: a method of overbridging large segmental gaps. Z Kinderchir 13: 298–306
Marujo WC, Tannuri W, Maksoud JG (1991) Total gastric transposition: an alternative to esophageal replacement in children. J Pediatr Surg 26: 676–681
Nakazo Y, Landing BH, Wells TR (1986) Abnormal Auerbach plexus in the esophagus and stomach of patients with esophaeal atresia and tracheoesophageal fistula. J Pediatr Surg 21: 831–837
Orringer MB, Kirsh MM, Sloan H (1977) Long-term esophageal function following repair of esophageal atresia. Ann Surg 186: 436–443
Puri P, Blake N, O'Donnell, Guiney EI (1981) Delayed primary anastomosis following spontaneous growth of esophageal segments in esophageal atresia. J Pediatr Surg 16: 180–185
Puri P, Ninan GK, Blake NS, et al (1981) Delayed primary anastomosis for esophageal atresia: 18 months to 11 years follow up. J Pediatr Surg 16: 180–185
Rehbein F, Schweder N (1972) Reconstruction of the esophagus without colon transportation in cases of atresia. J Pediatr Surg 6: 746–752
Schaerschmidgt GH, Willital GD, Kerremanns J (1992) Delayed primary reconstruction of an esophageal atresia with distal esophagotracheal fistula in an infant weighing less than 500 g. J Pediatr Surg 27: 1529–1531
Shafer AD, David TE (1974) Suture fistula as a means of connecting upper and lower segments in esophageal atresia. J Pediatr Surg 9: 669–673
Spitz L, Kiely E, Sparnon T (1987) Gastric transposition for esophageal replacement in children. Ann Surg 206: 69–73
Waterston DJ, Boneham-Carter RE, Aberdeen E (1962) Oesophageal atresia: tracheo-oesophageal fistula. A study of survival in 218 infants. Lancet 1: 819–822
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Brown, A.K., Gough, M.H., Nicholls, G. et al. Anterior flap repair of oesophageal atresia: a 16-year evaluation. Pediatr Surg Int 10, 525–528 (1995). https://doi.org/10.1007/BF00566488
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00566488