title: Measured gap length and outcomes in oesophageal atresia.
abstract: OBJECTIVE
  Oesophageal atresia (OA) with or without tracheoesophageal fistula (TOF) is the most common congenital anomaly of the oesophagus. There is limited literature suggesting a linear relationship between increasing gap length and the incidence of all major complications. We sought to assess whether measured gap length at the time of surgery was related to outcomes in our patients.
  
  
  METHODS
  All patients with a diagnosis of OA +/- TOF who underwent repair under a single surgeon between 1983 and 2012 were included. The length between the oesophageal pouches was measured at the time of surgery. Patients were then divided into three groups; short ≤1cm, intermediate >1-≤2cm and long >2-≤5cm. Outcome measures were anastomotic leak, strictures requiring dilatation, gastrooesophageal reflux disease (GORD) and need for fundoplication.
  
  
  RESULTS
  122 patients were included in the study. The outcomes for patients with short (n=53), intermediate (n=51) and long gaps (n=18) were as follows: anastomotic leak - 1.9%, 2%, 5.5% (P=0.66), strictures requiring dilatation - 32%, 33%, 50% (P=0.67), GORD - 51%, 59%, 72% (P=0.58) and need for fundoplication - 11%, 20%, 44% (*P=0.02). There were no deaths related to the repair.
  
  
  CONCLUSIONS
  Measured gap length at the time of surgery did not have a linear relationship with leak or stricture rate. Our experience suggests that when primary repair is possible absolute gap length is irrelevant to the development of post-operative complications. There is however a significant increase in the need for fundoplication in those with a long gap.
authors.affiliation: Division of Paediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK. Electronic address: hemanshoo@gmail.com.
authors.forename: Hemanshoo S
authors.initials: HS
authors.lastname: Thakkar
authors.affiliation: Division of Paediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Cooney
authors.affiliation: Division of Paediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK.
authors.forename: Neetu
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Division of Paediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Kiely
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology; D004106:Dilatation; D004933:Esophageal Atresia / Q000473:pathology* / Q000601:surgery*; D004940:Esophageal Stenosis / Q000628:therapy; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000628:therapy; D014138:Tracheoesophageal Fistula / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Anastomotic leak; Fundoplication; Gap-length; Oesophageal atresia; Reflux; Strictures