Selective surgical management based upon clinical status in infants with esophageal atresia
Randolph, J.G.; Altman, R.P.; Anderson, K.D.
Journal of Thoracic and Cardiovascular Surgery 74(3): 335-342
1977
ISSN/ISBN: 0022-5223 PMID: 895169 Document Number: 122279
Patients (56) with esophageal atresia and distal tracheoesophageal fistula (Vogt-Gross type C) were treated since 1966. The methods of treatment were individualized according to gestational age, birth weight, pulmonary status and coexistence of other major anomalies. Three distinct approaches have evolved; immediate primary repair is reserved for infants weighing more than 2 kg with no major anomalies and satisfactory pulmonary status. Delayed primary repair is used in infants of adequate weight (more than 2 kg) who have significant but reversible pulmonary changes, with anticipated recovery within 1 wk, and in those in whom several days are required for evaluation of an associated congenital anomaly; they are temporized by upper pouch suction, gastrostomy and antibiotics. Staged repair is used in premature and severely distressed infants and in those with cardiac lesions of surgical priority; staging consists of upper pouch suction, gastrostomy, retropleural division of the fistula, or gastric division, with subsequent transpleural repair in 4-8 wk. The surgical approach to each of these infants was selected after assessment of all aspects of their clinical condition. Flexibility in treatment, which is predicated upon previously established criteria, seems superior to any single surgical plan.