Esophageal Atresia: Management and Outcome in Resource Limited Settings
Background: Esophageal Atresia (EA) with or without associated tracheo-esophageal fistula (TEF) is one of the common congenital anomaly that can be life threatening if left unattended. In low and middle income countries like Pakistan, the management and outcome of such type of cases depends upon many factors related to resource limitation.
Objective: To prospectively evaluate the management and outcome of esophageal atresia at Children Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan.
Study design, settings and duration: An Observational- descriptive study was conducted at the Department of Pediatric Surgery, The Children Hospital, PIMS, Islamabad from October 2017 to August 2018.
Methodology: Consecutive patients diagnosed with esophageal atresia were included in the study. Demographic data, investigations, procedure performed and outcome were collected on a pre designed proforma and results were analysed.
Results: Total 140 consecutive patients of esophageal atresia were enrolled in study. Out of 140 patients, 79 (56.4%) were male and 61 (43.6%) were female. Mean age at presentation of esophageal atresia was 5.5 days (ranged from 1-30 days). Mean weight was 2.43 kg. Regarding type of esophageal atresia, 10 (7.1%) patients had type A, 97 (69.3%) had type C, 1 (0.7%) had type E and 1 (0.7%) had type F esophageal atresia. Nine patients with type A underwent cervical esophagostomy along with feeding gastrostomy. Right thoracotomy was performed in 98 cases. End to end esophageal anastomosis was possible in 76 patients. Twenty one patients had long gap EA for which cervical esophagostomy and feeding gastrostomy was done. Sepsis was the main complication post operatively (29.3%) followed by pneumonia (14.3%), Anastomotic leak (7.9%) and surgical site-infection (2.1%). Overall mortality was 57.9% (81/140) with pre operative mortality of 21.4% (30/140) and post operative mortality of 36.5% (51/140). Low birth weight and post operative sepsis, anastomotic leak and pneumonia had statistically significant relationship with mortality using SPSS version 21.
Conclusion: With the improvement of medical facilities, better survival rates of patients with esophageal atresia can be achieved.
(1) Department of Paediatric Surgery,The Children’s Hospital PIMS, Islamabad.
(2) Mohiuddin Islamic Medical College, Mirpur, Azad Jammu & Kashmir
(3) Maternal & Child Health, PIMS, Islamabad
(4) PAEC General Hospital, Islamabad.
(5) The Children’s Hospital PIMS, Islamabad.
(6) The Children’s Hospital PIMS, Islamabad.
(*) Corresponding Author