[Esophageal atresia with distal tracheo-esophageal fistula. Evolution of the treatment in the period of 1955-2000 at the Anna Meyer Children's Hospital of Florence].
BACKGROUND
Over the past decades the esophageal atresia (EA) has represented the greatest challenging malformation encountered by the pediatric surgeon. Since then, there have been considerable advancements in the treatment of EA. In this paper the experience at the "Anna Meyer Children's Hospital of Florence" in regards to the surgical treatment of the EA from 1955 to present day is reported, so that the analysis of the various medical and surgical choices followed by the authors and their predecessors in this long period, can be an important learning tool for the EA management.


METHODS
From 1955 to 2000, 223 newborns affected by EA with tracheoesophageal fistula (TEF) have been operated on out of a total of 250 cases of EA. Our experience has been subdivided into periods on the basis of homogeneous medical and surgical treatment adopted in that determined time. We have analyzed particularly the data of the last period 1995-2000, where there has been a well standardized protocol of treatment from the medical, surgical and intensive care points of view.


RESULTS
The mortality rate has decreased from 44.8 to 3.4% with a significant reduction (p<0.001) between the years 1979-1983 and 1984-2000, due to the introduction of a perioperative treatment in the newborn intensive care unit. Moreover, a significant correlation (p<0.05) has been shown between low birthweight and associated malformations, two risk factors that however do not negatively influence the results of the treatment in the last period 1995-2000.


CONCLUSIONS
A full integration between the surgeon and neonatologist is necessary in order to guarantee a good result. The risk connected to EA is not as much the surgical procedure as the presence or absence of associate malformations that are undetected in the prenatal diagnosis. It is suggested that, in order to further reduce the mortality and morbidity rate after EA correction, the number of prenatal diagnoses should be increased.
Noccioli
B
B
U.O. di Chirurgia Pediatrica, Ospedale Pediatrico Anna Meyer, Firenze, Italy. brunonoccioli@libero.it
Pampaloni
F
F
Fiorini
P
P
Mattei
R
R
Pancani
S
S
Elia
A
A
Donzelli
G P
GP
Pampaloni
A
A
D004933:Esophageal Atresia / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D004937:Esophageal Fistula / Q000209:etiology / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D014133:Tracheal Diseases / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome