title: Esophageal atresia/tracheoesophageal fistula in very low-birth-weight neonates: improved outcomes with staged repair.
abstract: BACKGROUND
  The surgical management of esophageal atresia with distal tracheoesophageal fistula (EA/TEF) involves early division of the TEF and primary esophageal anastomosis. However, in premature infants, the morbidity associated with primary repair remains high, and the optimal surgical approach has not been well defined.
  
  
  METHODS
  Medical records of very low-birth-weight infants (<1500 g) with EA/TEF from June 1987 to 2008 were retrospectively reviewed. Patients were separated into 2 groups: (1) primary repair and (2) ligation and division of TEF followed by delayed repair of EA. Demographics, anastomotic, and postoperative complications were compared.
  
  
  RESULTS
  Twenty-five premature infants with EA/TEF were identified. Sixteen patients (64%) underwent primary repair, and 9 (36%) were repaired in a staged manner. The leak rate confirmed by esophagram was significantly higher after primary repair (50%) compared to staged repair (0%) (P = .034). Strictures occurred significantly more often in the primary repair (81%) vs the staged repair (33%) group (P = .036). Postoperative pneumonia and sepsis were significantly higher in patients treated with primary repair (P = .028).
  
  
  CONCLUSIONS
  Staged repair of EA/TEF in very low-birth-weight premature infants results in a significantly lower rate of anastomotic complications and overall morbidity and should be considered the preferred surgical approach in this group of patients.
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA.
authors.forename: Mikael
authors.initials: M
authors.lastname: Petrosyan
authors.forename: Joaquin
authors.initials: J
authors.lastname: Estrada
authors.forename: Catherine
authors.initials: C
authors.lastname: Hunter
authors.forename: Russell
authors.initials: R
authors.lastname: Woo
authors.forename: James
authors.initials: J
authors.lastname: Stein
authors.forename: Henri R
authors.initials: HR
authors.lastname: Ford
authors.forename: Dean M
authors.initials: DM
authors.lastname: Anselmo
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery; D000714:Anastomosis, Surgical / Q000379:methods; D015897:Comorbidity; D004933:Esophageal Atresia / Q000453:epidemiology / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008137:Longitudinal Studies; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology; D013536:Suture Techniques; D014138:Tracheoesophageal Fistula / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome