Evolution in the treatment of congenital esophageal atresia within 20 years conducted in University Children’s Hospital, Jagiellonian University, Cracow : analysis of complications and long-term results.
The analysis for years 1990-2010 was done.Group:Patients no:120,Birthweight:[<=1500g-14(12,7%),1501-2500g 42(38,2%), >2 500g 54(49,1%)]EA Type: Distal TEF(Gross C) 90(81,8%)No TEF(Gross A) 20(18,2%)Assoc. anomalies: No anomaly 27(24,5%),Cardiac 36 (32,7%), Aliment. tr. 17 (15,4%),Genetic 9 (8,2%)Treatment: No Surgery 7(6%), Primary anastom. 90 (82%), Delayed anastom.13(18%),Circular myotomy 6,Gastric pull-up 5,Magnetic elongation and anastomosis 1, Foker op. 1Mortality: Children operated 26/103(25%)Conclusions:1.Statistically significant correlation was found between mortality rate and occurrence of: low birth weight, cardiac defects, isolated anorectal malformations and genetic defects.2.In the group Gross A we found no statistically significant correlation between birthweight and mortality rate. This is all the more surprising because such a correlation is the base of all traditional risk factor.3.When anastomosis is extremely risky, we recommend circular myotomy.4.When reconstruction of own esophagus is impossible, gastric pull-up procedure can be used as a first choice.5. In our conditions the esophagus elongation and neodymium magnets anastomosis procedure requires extensive work input. It will be a powerful tool in solving problems with long gap EA. This is confirmed by obtaining a patent in the USA and admittance for use of a device based on EA treatment methods.