PURE ESOPHAGEAL ATRESIA - OUTLOOK IN THE 1990S

Eleven newborns with pure esophageal atresia were treated between 1980 and 1989 inclusive; there were six girls and five boys. Their gestational age ranged from 31 to 40 weeks (average, 37 weeks) and weight from 1.1 to 3.0 kg (average, 2.2). The only associated anomalies were Down's syndrome, respiratory distress syndrome, and patent ductus arteriosus. All babies received an immediate gastrostomy. Several radiologic studies were done to see if the distance between the two esophageal pouches was decreasing. Dilatations of the upper pouch were carried out in two patients. After a wait of 1 to 7 months (average, 3 1 2) a primary anastomosis was attempted; the weight of six babies doubled during this time. Eight neonates had a primary repair (two were aided by a circular myotomy). Two had a staged gastric tube constructed, and one baby had a gastric pull-up procedure. Three of the infants with a primary anastomosis required a subsequent antireflux operation, and one needed her anastomosis resected 16 months later. Ten of these 11 newborns are alive and well; one of the gastric tube children died from an adhesive small bowel obstruction at age four years. We conclude that: (1) newborns who have a pure esophageal atresia occur at a ratio of one to every 15 neonates with the common type of esophageal atresia and distal tracheoesophageal fistula; (2) there are few associated congenital defects; (3) primary repair is successful in three quarters of such infants if the wait is past 3 months and/or the newborn weight is at least doubled; (4) one third of the primary repair babies will require antireflux surgery within 3 months of the primary anastomosis; and (5) survival rate is over 90%. © 1993.