title: Determinants of gap length in esophageal atresia with tracheoesophageal fistula and the impact of gap length on outcome.
abstract: OBJECTIVE
  This study was aimed at identifying factors which may affect the gap length in cases of esophageal atresia with tracheoesophageal fistula (EA-TEF) and whether gap length plays any role in determining the outcome.
  
  
  METHODS
  All consecutive cases of EA-TEF were included and different patient parameters were recorded. Plain radiographs with a nasogastric tube in the upper esophagus were taken. Patients were grouped into T1-T2; T2-T3; T3-T4; and T4 depending on the thoracic vertebral level of the arrest of the tube. During surgery, the gap length between the pouches was measured using a Vernier caliper and the patients were grouped into A, B, and C (gap length >2.1 cm; >1-≤2 cm and ≤1 cm). The operative gap groups were compared with the radiography groups and the other recorded parameters.
  
  
  RESULTS
  Total numbers of cases were 69. Birth weight was found to be significantly lower in Group A (mean = 2.14 kg) as compared to Group B (mean = 2.38 kg) and Group C patients (mean = 2.49 kg) (P = 0.016). The radiographic groups compared favorably with the intraoperative gap length groups (P < 0.001). The need for postoperative ventilation (70.83% in Group A vs. 36.84% in Group C, P = 0.032) and mortality (62.5%, 26.9% and 15.8% in Group A, B, and C, respectively, P = 0.003) co-related significantly with the gap length.
  
  
  CONCLUSIONS
  Birth weight had a direct reciprocal relationship with the gap length. Radiographic assessment correlated with intraoperative gap length. Higher gap length was associated with increased need for postoperative ventilation and poor outcome.
authors.affiliation: Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors.forename: Muffazzal
authors.initials: M
authors.lastname: Rassiwala
authors.affiliation: Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors.forename: Subhasis Roy
authors.initials: SR
authors.lastname: Choudhury
authors.affiliation: Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors.forename: Partap Singh
authors.initials: PS
authors.lastname: Yadav
authors.affiliation: Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors.forename: Praveen
authors.initials: P
authors.lastname: Jhanwar
authors.affiliation: Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors.forename: Raghu Prakash
authors.initials: RP
authors.lastname: Agarwal
authors.affiliation: Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Chadha
authors.affiliation: Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors.forename: Pinaki Ranjan
authors.initials: PR
authors.lastname: Debnath
keywords: Esophageal atresia; gap length; tracheoesophageal fistula