[Analysis of clinical-surgical course of neonates with long-gap esophageal atresia during their spontaneous growth].
BACKGROUND
Esophageal atresia (EA) is one of the most prevalent surgical conditions in the newborn. Sometimes early oesophageal anastomosis can't be done due to the esophageal gap. Long gap (LG) definition is not precise. Although consensus exist about conservation of owns esophagus is the best therapeutic option, literature is not clear about how long and under what circunstances is advisable to wait for the spontaneous esophageal pouches to growth (P. Puri approach). Furthermore at present we don't even know the real repercussion that this waiting can implicate.


OBJECTIVE
The aim of the study was to evaluate the clinical and surgical outcome of newborns with EALG during their stay in a neonatal intensive care unit (NICU) at a third level children's hospital.


METHODS
We retrospectively reviewed the charts of all newborn with EA admitted in the NICU from January 2002 to December 2006 in order to analyze sex, gestacional age, weight, type of EA, LG, respiratory and surgical complications, length of stay and mortality.


RESULTS
During the study time period 64 newborns with EAwere admitted, 21 (33%) had EALG (our population). We underwent primary repair with esophageal anastomosis in 8 newborns at 80 +/- 40 days. All of them had gastroesophageal reflux, 50% presented different complications such as anastomotic leak, stricture and mediastinal infections. 13 patients required an esophagostomy at a mean age of 46 +/- 34 days due to a lack of growth of esophageal's pouches and/or serious respiratory complications. There were no deaths.


CONCLUSIONS
There were high percentages of esophagostomized patients. The result of waiting for the primary repair was a high number of children with chronic lung disease and a high rate of serious complications. Esophageal anastomosis were accompanied by long hospital stays and no clear benefits. The early application of dynamic esophageal lengthening should be explored as an alternative strategy for newborns with EALG.
Cannizzaro
C
C
Area Cuidados Intensivos Neonatales, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina. ccanizza@gmail.com
Boglione
M
M
Rodríguez
S
S
Reussman
A
A
Martínez Ferro
M
M
D004933:Esophageal Atresia / Q000150:complications / Q000601:surgery*; D004947:Esophagus / Q000254:growth & development; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies