Management and outcome of oesophageal atresia and tracheoesophageal fistula in pediatrics : our experience at Queen Rania Al-Abdullah Hospital for Children

الملخص EN

Objective: To report our experience at Queen Rania Al-Abdullah Hospital for Children (QRHC) in the management of oesophageal atresia (EA) and tracheoesophageal fistula (TEF) regarding prognostic predictors, outcome, complications, survival and death rates.

Method: A retrospective study was conducted by reviewing the medical records of patients with EA-TEF who were admitted to QRHC in the period from March 2017 to November 2019.

Total number of cases was 40; 26 males and 14 females with a male to female ratio of 1.86:1.

The post-operative follow up period ranged from 8 to 24 months (mean was 18 months).

Demographic data, complications, survival and death rates were collected to analyse our outcome.

Results: Out of our 40 patients, 34 (85%) cases were EA Gross type C, 5 (12.5%) were type A and 1 (2.5%) case was type H.

Patient mean age was 22.5 hours (ranging from 5 hours to 3 days), mean body weight was 2.1 kg (ranging from 1.1 to 3.6 kg) and mean gestational age was 33.5 weeks (ranging from 28 to 38 weeks).

Congenital anomalies were seen in 60% (24 patients); the most common was cardiac, which presented in 50% (12 patients), while the second most common was urogenital anomalies in 33% (8 patients).

The VACTERL association was demonstrated in one patient.

No chromosomal anomalies were detected.

The survival rate was 80% (32 cases); the 8 patients who died were premature, 7 (87.5%) of whom had a low birth weight (less than 2.5 kg) and 5 (62.5%) of whom had cardiac anomalies.

Regarding complications, 27.5% complained of Gastroesophageal Reflux Disease (GERD) (11 cases), 20% developed oesophageal anastomotic stricture (8 cases) and 10% developed anastomotic oesophageal leak (4 cases).

Conclusion: The main prognostic predictors of outcome in the management of EA-TEF were gestational age (GA), birth weight (BW) and associated congenital anomalies, mainly cardiac.

The survival rate is improving due to advances in neonatal ICU, anaesthetics and surgical techniques.