Comparison of outcomes according to the operation for type A esophageal atresia.
OBJECTIVE
The purpose was to evaluate outcomes according to different operative strategies of type A esophageal atresia (EA).


METHODS
All patients who underwent surgery for type A EA between 1980 and 2011 were included. Patients were divided into 2 groups: E-E group included patients who received esophageal end-to-end anastomosis, whereas E-G group included patients who received esophago-gastric tube anastomosis.


RESULTS
Twenty-two patients were included. The median gestational age was 37.5 weeks. The median birth weight was 2.5 kg. Twenty-one patients underwent gastrostomy as initial procedures, and one patient underwent primary esophageal end-to-end anastomosis. The median gap between both esophageal ends was six vertebral distance (VD). Seven patients underwent primary anastomosis of the esophagus, and 14 patients underwent gastric replacement. Three patients (13.6%) had anastomotic leakage and 10 patients (45.5%) had anastomotic stenosis. Most of the patients (90.9%) had gastroesophageal reflux, but only two patients required antireflux surgery. The median VD was significantly shorter in E-E group than in E-G group (3 VD vs. 6 VD). Stenosis was significantly more often in E-E group, but there was no significant difference in leakage and reflux symptoms.


CONCLUSIONS
The treatment for type A EA can include E-E anastomosis or E-G anastomosis, depending on the length of the end-to-end interval after performing gastrostomy. Appropriate tension and blood flow in the anastomosis site are essential for preventing postoperative stenosis and leakage, and esophageal replacement with gastric tube is believed to be feasible and safe in cases where excessive tension is present.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Yeon-Ju
YJ
Huh
Division of Pediatric Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Hyun-Young
HY
Kim
Division of Pediatric Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Seong-Cheol
SC
Lee
Division of Pediatric Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Kwi-Won
KW
Park
Division of Pediatric Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Sung-Eun
SE
Jung
Esophageal atresia; Operations