Type A esophageal atresia: a critical review of management strategies at a single center.
OBJECTIVE
The purpose of was to study the short- and long-term outcomes in the management of isolated esophageal atresia with different operative strategies.


METHODS
All patients undergoing type A atresia repair over a 15-year period were included. Demographic data, birth weight, gestational age, incidence of associated anomalies, management, and long-term outcomes were studied.


RESULTS
Fifteen patients with type A atresia (9 male) were treated in the study period. The mean gestational age was 35.5 weeks (range, 27-39 weeks), and the mean birth weight was 2179 g (range, 670-3520 g). Eight babies had associated anomalies. Thirteen patients underwent gastrostomy as the initial procedure, and 2 underwent the Foker procedure. In the delayed management group, 9 patients underwent primary anastomosis, with 2 patients needing proximal pouch myotomy. Two patients underwent a Collis gastroplasty. Two patients underwent a cervical esophagostomy and a gastric tube replacement at 4 months and 1 year, respectively. Eight patients (60%) in this group had anastomotic leaks. All patients are currently on prokinetics and proton pump inhibitors. Seven required antireflux surgery. The median length of hospital admission was 4 months (range, 3-19 months). The native esophagus was preserved in 13 (85%) of 15 babies. All patients are alive, and 14 of 15 are capable of feeding orally.


CONCLUSIONS
Type A esophageal atresia continues to be associated with significant morbidity despite advances in surgical technique and intensive care.
Burjonrappa
Sathyaprasad
S
Division of Pediatric Surgery, Department of Surgery, New York Medical College, Valhalla, NY 10595, USA. sathyabc@yahoo.com
Thiboutot
Eva
E
Castilloux
Julie
J
St-Vil
Dickens
D
D000714:Anastomosis, Surgical; D004933:Esophageal Atresia / Q000601:surgery*; D004944:Esophagoplasty; D004946:Esophagostomy; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery; D015391:Gastroplasty; D006801:Humans; D007223:Infant; D008297:Male; D009518:New York; D011183:Postoperative Complications; D012086:Reoperation; D016896:Treatment Outcome