Primary repair of esophageal atresia in extremely low birth weight infants: a single-center experience and review of the literature.
BACKGROUND
Advances in neonatal intensive care have led to an increased survival of very low birth weight (VLBW, <1,500 g) and extremely low birth weight infants (ELBW, <1,000 g). Several abnormalities may occur in these children, e.g. esophageal atresia (EA), imperforate anus or abdominal wall defects. Correction of EA is often performed as a staged procedure in this group of patients.


OBJECTIVE
To evaluate the feasibility of a primary correction of EA in 4 ELBW and VLBW infants.


METHODS
Between 2002 and 2004, 4 infants below 1,200 g were operated on in our institution with a diagnosis of EA with lower tracheoesophageal fistula. Birth weight ranged from 780 to 1,120 g (median: 920 g), gestational age from 28 to 30 weeks. Treatment included closure of the tracheoesophageal fistula and primary anastomosis of the esophagus in a one-step procedure.


RESULTS
Primary correction of EA and fistula repair was feasible in all children. Initially, all children had a normal passage of the esophagus as observed in barium swallowing. One child suffering from a leakage of the anastomosis was managed conservatively. Another infant suffered from spontaneous small bowel perforation 6 days after surgery, which was treated by laparotomy. One child developed stenosis of the esophagus and required a single dilatation 14 months after initial treatment. In the 4th child, a type II cleft syndrome was subsequently diagnosed, requiring secondary cleft repair together with semifundoplication. This child eventually died from cytomegalovirus pneumonia.


CONCLUSIONS
Primary repair of EA and closure of a tracheoesophageal fistula is technically feasible and offers a good treatment option for ELBW and VLBW infants. Staged repair can be avoided. Infants with cleft syndrome are still a diagnostic and therapeutic challenge.
Seitz
Guido
G
Department of Pediatric Surgery, University Children's Hospital, Tübingen, Germany. guido.seitz@med.uni-tuebingen.de
Warmann
Steven W
SW
Schaefer
Juergen
J
Poets
Christian F
CF
Fuchs
Joerg
J
D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D004933:Esophageal Atresia / Q000473:pathology / Q000601:surgery*; D004944:Esophagoplasty / Q000009:adverse effects / Q000379:methods; D004947:Esophagus / Q000473:pathology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D015931:Intensive Care, Neonatal / Q000379:methods; D008297:Male