Prognostic Factor of Congenital Esophageal Atresia

Lee, Dae Sung; Kim, Hong Ju; Bae, Byeng No; Kim, Ki Hwan; Han, Se Hwan; Kim, Young Duk; Kim, Hong Yong

Abstract

PURPOSE: This study was undertaken in order to analyze clinical data concerning cases of esophageal atresia cases we encountered to elucidate the risk factors that may more accurately predict a prognosis.
METHODS
We retrospectively reviewed the medical charts of 19 infants with esophageal atresia diagnosed at Sanggye Paik Hospital from June 1991 to May 2000.
RESULTS
The mean birth weight of the infants was 2.46 kg (0.97~3.99 kg). Associated anomalies occurred in 12 infants (63.2%), including cardiovascular anomalies in 10 (52.6%), anorectal anomaly in 1 (5.3%), renal anomaly in 1 (5.3%), skeletal anomaly in 1 (5.3%) and chromosomal anomaly in 1 (5.3%). We performed primary end-to-end anastomosis with one layer of interrupted suture in 12 infants. Primary repair was carried out in 7 infants, simultaneously with gastrostomy in 1, and gastrostomy & delayed end-to-end anastomosis was performed in 4. Postoperative complications included pneumonia in 8 (66.7%), leakage in 4 (33.3%), stricture in 4 (33.3%), sepsis in 2 (16.7%), wound infection in 1 (8.3%) and gastroesophageal reflux in 1 (8.3%). The postoperative mortality rate was 25.0% (3/12). Causes of death included sepsis (n=2) & heart failure (n=1). According to the Waterston criteria, 4 infants (21.1%) were classified as group A, 6 (31.6%) as group B, and 9 (47.3%) as group C. The postoperative survival rates of group A, B, and C were 100% (3/3), 80% (4/5), and 50% (2/4) respectively. The postoperative survival rates of class I and class II by Montreal classification were 88.9% (8/9) and 33.3% (1/3), respectively.
CONCLUSION
Our data suggests that associated anomalies and general conditions are more important prognostic factors than birth weights in patients with esophageal atresia.