Long-term outcomes of oesophageal atresia without or with proximal tracheooesophageal fistula - Gross types A and B

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http://hdl.handle.net/10138/298135

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Koivusalo , A I , Sistonen , S J , Lindahl , H G , Rintala , R J & Pakarinen , M P 2017 , ' Long-term outcomes of oesophageal atresia without or with proximal tracheooesophageal fistula - Gross types A and B ' , Journal of Pediatric Surgery , vol. 52 , no. 10 , pp. 1571-1575 . https://doi.org/10.1016/j.jpedsurg.2017.04.021

Title: Long-term outcomes of oesophageal atresia without or with proximal tracheooesophageal fistula - Gross types A and B
Author: Koivusalo, Antti I.; Sistonen, Saara J.; Lindahl, Harry G.; Rintala, Risto J.; Pakarinen, Mikko P.
Contributor: University of Helsinki, Lastenkirurgian yksikkö
University of Helsinki, Clinicum
University of Helsinki, Clinicum
University of Helsinki, Clinicum
University of Helsinki, Lastenkirurgian yksikkö
Date: 2017-10
Language: eng
Number of pages: 5
Belongs to series: Journal of Pediatric Surgery
ISSN: 0022-3468
URI: http://hdl.handle.net/10138/298135
Abstract: Purpose: Because of an extended gap between esophageal pouches a variety of methods are employed to treat oesophageal atresia (OA) without (type A) or with (type B) proximal tracheooesophageal fistula. This retrospective observational study describes their single centre long-term outcomes from 1947 to 2014. Methods: Of 693 patients treated for OA 68 (9.7%) had type A (n = 58, 8.3%) or B (n = 10, 1.4%). Hospital records were reviewed. Main outcome measures were survival and oral intake. Results: Nine (13%) patients had early and 10 (15%) delayed primary anastomosis, 30 (44%) underwent reconstruction including colonic interposition (n = 13), reversed gastric tube (n = 11) and jejunum interposition (n = 6), whereas19 (28%) had died without a definite repair. Median follow up was 35 (interquartile range, 7.4-40) years. Thirty-one (63%) of 49 patients with definitive repair survived long term. Survival was 22% for early and 80% for delayed primary anastomosis, 57% for colon interposition, 82% for gastric tube and 84% for jejunum interposition. Gastrooesophageal reflux was most common after gastric tube (80%), dysphagia after colon interposition (50%), and 3 (60%) of 5 survivors with jejunum interposition had permanent feeding ostomy because of neurological disorder. Endoscopic follow-up disclosed no oesophageal cancer or dysplasia. Repair in the most recent patients from 1985 to 2014 (n = 14) included delayed primary anastomosis (n = 7), jejunum interposition (n = 6) and gastric tube (n = 1) with 93% long-term survival. Conclusion: Morbidity among long-term survivors of type A or B OA is high. With modern management survival is, however, excellent and patients without neurological disorder achieve full oral intake either after primary anastomosis or reconstruction. (C) 2017 Elsevier Inc. All rights reserved.
Subject: Oesophageal atresia
Primary repair
Gastric tube
Colon interposition
Jejunum interposition
GASTRIC TRANSPOSITION
FOLLOW-UP
COLON INTERPOSITION
SINGLE-CENTER
CONGENITAL ATRESIA
CHILDREN
REPLACEMENT
EXPERIENCE
TUBE
REPAIR
3123 Gynaecology and paediatrics
3126 Surgery, anesthesiology, intensive care, radiology
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