Esophageal atresia: comparison between survivors and mortality cases who underwent surgery over a 2-year period in two referral hospitals, Tehran, Iran

Abstract

Introduction and aim The aim of this study was to compare the type of suture, technique of suture, and technique of anastomosis between survivors and mortality cases.
Patients and methods This study was conducted in Bahrami Hospital and Children’s Medical Center on cases with esophageal atresia who underwent surgery for esophageal atresia and/or tracheoesophageal fistula repair. The places of study were Bahrami Hospital and Children’s Medical Center, two referral centers for pediatric surgery in Tehran. The duration of the study was 2 years, starting from April 1999. Survivors and mortality cases were compared with regard to sex, type of surgery, suture material, and technique of anastomosis. Gross classification was used for typing of anomaly. All data were analyzed again using SPSS ver. 13.0 and Epi-info ver. 6.04d (CDC,WHO). The v2-test was used for comparison.
Results In this study, 21 (male = 9, female =12) mortality cases and 53 (male = 29, female =24) survivors were included. Among them, 18 (85.7%) mortality cases and 51 (96.2%) survivors had type C atresia (P = 0.23). Thoracotomy and repair of atresia was performed in 10 (47.6%) mortality cases and 51 (96.2%) survivors. Gastrostomy and tracheoesophageal fistula repair was performed in eight (38.1%) mortality cases. Gastrostomy and cervical esophagostomy was performed in three (14.7%) mortality cases and two (3.8%) survivors. Anastomotic leak was noted in eight mortality cases and 10 survivors who underwent thoracotomy and atresia repair (P = 0.0005). End-to-end anastomosis was performed for nine mortality cases and 45 survivors (P = 0.7). Extrapleural thoracotomy was performed in nine mortality cases and 45 survivors (P = 0.7). Single-layer anastomosis was performed in eight mortality cases and 36 survivors (P = 0.82). There were no significant differences between survivors and mortality cases with regard to sex and type of atresia (P =0.23). Thoracotomy and atresia repair was more frequently performed in survivors than in mortality cases (P = 0.000004). Anastomotic leakage was significantly higher in mortality cases compared with survivors (P = 0.0005).
Conclusion Anastomosis leakage was associated with higher mortality. The rate of thoracotomy and atresia repair surgery is higher in survivors compared with mortality cases. 

Keywords: esophageal atresia, risk factors, surgical repair