Esophageal atresia/tracheoesophageal fistula in very low-birth-weight neonates: improved outcomes with staged repair.
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.
Petrosyan
Mikael
M
Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA.
Estrada
Joaquin
J
Hunter
Catherine
C
Woo
Russell
R
Stein
James
J
Ford
Henri R
HR
Anselmo
Dean M
DM
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