Outcomes in esophageal atresia and tracheoesophageal fistula.
OBJECTIVE
The purpose of this analysis was to investigate outcomes in newborns with esophageal atresia (EA) or tracheoesophageal fistula (TEF) with respect to prognostic classifications and complications.


METHODS
Charts of all 144 infants with EA/TEF treated at British Columbia Children's Hospital (BCCH) from 1984 to 2000 were reviewed. Patient demographics, frequency of associated anomalies, and details of management and outcomes were examined.


RESULTS
Applying the Waterston prognostic classification to our patient population, survival rate was 100% for class A, 100% for class B, and 80% for class C. The Montreal classification survival rate was 92% for class I and 71% for class II (P =.08). Using the Spitz classification, survival rate was 99% for type I, 84% for type II, and 43% for type III (P <.05). The Bremen classification survival rate was 95% "without complications" and 71% "with complications." Complications included stricture (52%), gastroesophageal reflux (31%), anastomotic leakage (8%), recurrent fistula (8%), and pneumonia (6%). Seventeen patients underwent fundoplication for gastroesophageal reflux, 16 pre-1992 and one post-1992.


CONCLUSIONS
Comparing the major prognostic classifications, the Spitz classification scheme was found to be most applicable. In our institution, the trend in management of gastroesophageal reflux after repair of EA/TEF has moved away from fundoplication toward medical management.
Konkin
David E
DE
Department of Surgery, British Columbia's Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
O'hali
Wael A
WA
Webber
Eric M
EM
Blair
Geoffrey K
GK
D000015:Abnormalities, Multiple / Q000401:mortality; D004933:Esophageal Atresia / Q000145:classification* / Q000401:mortality / Q000601:surgery; D005260:Female; D018662:Fundoplication; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D015996:Survival Rate; D014138:Tracheoesophageal Fistula / Q000145:classification* / Q000401:mortality / Q000601:surgery; D016896:Treatment Outcome