title: Revisional surgery for recurrent tracheoesophageal fistula and anastomotic complications after repair of esophageal atresia in 258 infants.
abstract: OBJECTIVE
  We assessed the occurrence and outcome of major reoperations following repair of esophageal atresia with or without tracheoesophageal fistula (TOF). Major outcome measures were survival, preservation of native esophagus, and long-term esophageal function.
  
  
  METHODS
  Hospital charts of 258 consecutive patients treated for esophageal atresia from 1980 to 2013 were reviewed.
  
  
  RESULTS
  Forty-two (16%) patients required a total of 57 reoperations after primary repair (n=37) or esophageal reconstruction (n=5). The indications were anastomotic leakage (n=17), anastomotic rupture after endoscopic dilatation (n=5), recurrent tracheoesophageal fistula (TOF) (n=12), undiagnosed proximal TOF (n=3), recalcitrant anastomotic stricture (n=11, primary anastomosis 9, reconstruction 2), undetected proximal fistula (n=3), and inadvertently perforated jejunal graft (n=1). Anastomotic leakage and rupture after dilatation were treated with rethoracotomy and suture and recurrent or undetected TOF by open repair. Strictures not manageable with repeated dilatations were resected and esophageal ends reanastomosed (n=10) or bridged with jejunum graft (n=1). Five (12%) patients required further reoperations, two after recurrent TEF (reocclusion n=1, reconstruction with gastric tube n=1), two after stricture operations (re-resection n=1, resuture after leakage n=1), and one after recurrent dilatation-related rupture. Mortality was 4/42 (10%). Two patients died of recurred leakage or TOF and two of unrelated cause. Of 38 survivors, 35 retained their native or initially reconstructed esophagus, and 3 had secondary reconstruction. After a median follow-up of 23 (range 0.6-32) years, 35 (95%) patients have acceptable esophageal function. Three patients remained dependent on gastrostomy feedings.
  
  
  CONCLUSIONS
  Anastomotic and TOF complications required a substantial number of reoperations, including esophageal reconstructions. Over 90% of the patients survived with a functioning native or reconstructed esophagus.
authors: Children's Hospital, Section of Paediatric Surgery, University of Helsinki, Helsinki, Finland. Electronic address: antti.koivusalo@hus.fi.
authors: Antti I
authors: AI
authors: Koivusalo
authors: Children's Hospital, Section of Paediatric Surgery, University of Helsinki, Helsinki, Finland.
authors: Mikko P
authors: MP
authors: Pakarinen
authors: Children's Hospital, Section of Paediatric Surgery, University of Helsinki, Helsinki, Finland.
authors: Harry G
authors: HG
authors: Lindahl
authors: Children's Hospital, Section of Paediatric Surgery, University of Helsinki, Helsinki, Finland.
authors: Risto J
authors: RJ
authors: Rintala
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology* / Q000601:surgery; D004933:Esophageal Atresia / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D014138:Tracheoesophageal Fistula / Q000209:etiology* / Q000601:surgery
keywords: Complications; Esophageal atresia; Surgical series; Tracheoesophageal fistula