Primary repair in esophageal atresia. The results of long term follow-up.
OBJECTIVE
The aim of this study was to assess the impact of postoperative morbidity during a long-term follow-up (6-12 years) in children with esophageal atresia treated at birth by primary anastomosis.


METHODS
Fifteen children with esophageal atresia and tracheoesophageal fistula were surgically treated at birth and their follow-up was extended to at least 6 up to 12 years. Data included clinical examination, evaluation of nutritional habit, continuous video recording of barium esophagogram, esophageal manometry, 24-h esophageal pH-monitoring and esophageal endoscopy.


RESULTS
All the 15 patients completed the clinical evaluation and the set of tests. In the first 6 years, mild dysphagia and gastroesophageal reflux (GER) was observed in 3 cases whereas GER without dysphagia in 4 cases. These 7 patients were informed about simple nutritional behaviours to minimize symptoms and treated with H2-blockers. At long-term twelve-year analysis, all patients were between 50 degrees and 75 degrees percentile of expected growth. It was not referred peculiar food restrictions. Five patients showed mild dysphagia with solid foods; early satiety, epigastric burning and regurgitation were less frequent. Furthermore they showed multiple non-peristaltic body contractions at esophagogram and moderate impairment of esophageal motility at esophageal manometry. The 24-h esophageal pH-monitoring showed normal patterns in all patients. No major lesions of esophageal mucosa were detected at esophagoscopy.


CONCLUSIONS
Although GER and esophageal dysmotility are reported as frequent findings in patients who underwent primary repair for esophageal atresia, these disorders don't cause any relevant impairment to the quality of their nutritional habit.
Pediatric Surgery Unit, University of Palermo, Palermo, Italy.
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M
Cimador
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Carta
M R
MR
Di Pace
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Natalè
A
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Castiglione
M
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Sergio
G
G
Corsello
E
E
De Grazia
D002648:Child; D003680:Deglutition Disorders / Q000209:etiology; D004933:Esophageal Atresia / Q000150:complications / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008365:Manometry; D012189:Retrospective Studies; D014138:Tracheoesophageal Fistula / Q000150:complications / Q000601:surgery*