title: Outcomes at one-year post anastomosis from a national cohort of infants with oesophageal atresia.
abstract: OBJECTIVE
  We aimed to provide a contemporaneous assessment of outcomes at one-year post oesophageal atresia/tracheoesophageal fistula (OA-TOF) repair, focussing particularly on post-operative complications. It is generally accepted that oesophageal stricture is the most common complication and causes significant morbidity. We also aimed to assess the efficacy of prophylactic anti-reflux medication (PARM) in reducing stricture formation.
  
  
  METHODS
  A prospective, multi-centre cohort study of all infants live-born with oesophageal atresia in the United Kingdom and Ireland in 2008/9 was performed, recording clinical management and outcomes at one year. The effect of PARM on stricture formation in infants with the type-c anomaly was assessed using logistic regression analysis.
  
  
  RESULTS
  151 infants were live-born with oesophageal atresia in the defined reporting period, 126 of whom had the type-c anomaly. One-year follow-up information was returned for 105 infants (70%); the mortality rate was 8.6% (95% CI 4.7-14.3%). Post-operative complications included anastomotic leak (5.4%), recurrent fistula (3.3%) and oesophageal stricture (39%). Seventy-six (60%) of those with type-c anomaly were alive at one-year with returned follow-up, 57(75%) of whom had received PARM. Of these, 24 (42%) developed a stricture, compared to 4 (21%) of those who had not received PARM (adjusted odds ratio 2.60, 95% CI 0.71-9.46, p = 0.147).
  
  
  CONCLUSIONS
  This study provides a benchmark for current outcomes and complication rates following OA-TOF repair, with oesophageal stricture causing significant morbidity. The use of PARM appeared ineffective in preventing strictures. This study creates enough doubt about the efficacy of PARM in preventing stricture formation to warrant further investigation of its use with a randomised controlled trial.
authors.affiliation: National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom; Department of Paediatric Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Allin
authors.affiliation: National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom.
authors.forename: Marian
authors.initials: M
authors.lastname: Knight
authors.affiliation: Department of Paediatric Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Johnson
authors.affiliation: Department of Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Burge
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology*; D004933:Esophageal Atresia / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D007223:Infant; D007494:Ireland; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D014138:Tracheoesophageal Fistula / Q000601:surgery*; D006113:United Kingdom