Isolated tracheoesophageal fistula versus esophageal atresia - Early morbidity and short-term outcome. A single institution series.
OBJECTIVE
We compared the postnatal course, morbidity and early results after repair for cases of isolated or "pure" TEF with those for cases of esophageal atresia (EA) with distal tracheoesophageal fistula (TEF).


METHODS
Twenty-four consecutive infants were divided into two groups: isolated TEF [TEF group] (n = 5) and EA with distal TEF [EA group] (n = 19).


RESULTS
A high rate of prematurity (29%) and major cardiac and other surgically-relevant malformations (0.8 vs. 0.7 per infant) was found in both groups. The median age at surgery was 8 days for the TEF group vs. 1 day for the EA group (p < 0.01). Most infants of both cohorts had stable acid-base and respiratory parameters at admission. Generally, tracheoscopy provided valuable information regarding the position of the TEF. Surgery for isolated TEF was performed via right cervicotomy in 4 cases and via thoracotomy in one. Postoperative thoracostomy tubes were inserted in 3 cases and one emergency gastrostomy was created for acute gastric overextension (exclusively in patients with EA). The duration of postoperative mechanical ventilation (49 vs. 113 h, p = 0.045) and the median length of stay in the pediatric surgery unit (10 vs. 20.5 days, p = 0.003) were shorter for the isolated TEF group. Four EA patients experienced severe events. Total mortality was 8% (0 out of 5 with TEF vs. 2 out of 19 with EA).


CONCLUSIONS
Developmental delay and a high rate of morbidity were found in both groups. More complex surgery increased perioperative morbidity in cases of EA. With early recognition of isolated TEF, a less complicated course can be expected in comparison with esophageal atresia.
Department of Pediatric Surgery, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, D-44627, Herne, Widumer Str. 8, Germany. Electronic address: ralf-bodo.troebs@elisabethgruppe.de.
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Tröbs
Department of Anesthesiology and Surgical Intensive Care, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, D-44627, Herne, Widumer Str. 8, Germany. Electronic address: werner.finke@elisabethgruppe.de.
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Finke
Department of Pediatric Surgery, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, D-44627, Herne, Widumer Str. 8, Germany. Electronic address: micha.bahr@elisabethgruppe.de.
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Bahr
Vest Children's Hospital, University of Witten-Herdecke, Department of Neonatology and Pediatric Intensive Care, Dr. Friedrich-Steiner-Str. 5, D-45711, Datteln, Germany. Electronic address: c.roll@kinderklinik-datteln.de.
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Roll
Department of Pediatric Surgery, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, D-44627, Herne, Widumer Str. 8, Germany. Electronic address: matthias.nissen@elisabethgruppe.de.
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Nissen
Department of Pediatric Surgery and Pediatric Urology, University of Marburg, Universitätsklinikum, Baldingerstrasse, D-35043, Marburg, Germany. Electronic address: rvahdad@aol.com.
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Vahdad
Department of Pediatrics and Adolescent Medicine, Pediatric Surgery, University of Cologne, Kerpener Str. 26, D-50937, Cologne, Germany. Electronic address: grigore.cernaianu@uk-koeln.de.
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Cernaianu
D004724:Endoscopy; D004933:Esophageal Atresia / Q000150:complications / Q000601:surgery*; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D013907:Thoracostomy; D013908:Thoracotomy; D014138:Tracheoesophageal Fistula / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome
Esophageal atresia; Morbidity; Surgery; Tracheoesophageal fistula; Tracheoscopy