Thirty-five-year institutional experience with end-to-side repair for esophageal atresia.
OBJECTIVE
End-to-side repair (ES) with ligation of the tracheoesophageal fistula (TEF) reduces the risks of stricture and gastroesophageal reflux disease requiring operation compared with the end-to-end repair of esophageal atresia and distal TEF.


METHODS
Case series with institutional and historical control subjects.


METHODS
Referral children's hospital.


METHODS
One hundred thirty-four infants diagnosed as having esophageal atresia and distal TEF between June 30, 1968, and July 1, 2003.


METHODS
Ninety-six infants having ES and 38 having end-to-end repair.


METHODS
Patients were studied for overall survival, surgical complications, and well-being during the first year of life.


RESULTS
Survival was 95% vs 90% (patients undergoing ES vs end-to-end repair). Complications included anastomotic leak, 8% vs 13%; recurrent TEF, 7% vs 3%, with only 1 recurrence in the last 28 patients having ES; anastomotic stricture (requiring dilatation), 5% vs 13%; gastroesophageal reflux disease requiring operation, 6% vs 18%; and esophageal dysmotility, which was present following nearly all ES and end-to-end procedures. Tracheomalacia-related respiratory symptoms following ES decreased from 50% to 11% at 1 year of age. Age-appropriate diet following ES was achieved in 93% by 1 year; 5% experienced occasional dysphagia or choking episodes.


CONCLUSIONS
The ES operation is accompanied by a reduced rate of stricture and gastroesophageal reflux disease requiring operation compared with end-to-end repair. Earlier concerns regarding an unacceptable risk of recurrent TEF were not substantiated.
Touloukian
Robert J
RJ
Section of Pediatric Surgery, Yale University School of Medicine, and Yale-New Haven Children's Hospital, New Haven, Conn. 06520, USA. robert.touloukian@yale.edu
Seashore
John H
JH
D000714:Anastomosis, Surgical; D004933:Esophageal Atresia / Q000150:complications / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods*; D016019:Survival Analysis; D014138:Tracheoesophageal Fistula / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome