FACTORS AFFECTING SURVIVAL IN PATIENTS WITH OESOPHAGEAL ATRESIA AND TRACHEO-OESOPHAGEAL FISTULA
Abstract
Objective: To evaluate the various factors affecting survival in babies with oesophageal atresia andtracheo-oesophageal fistula. Design: Descriptive study. Setting: The study was carried out at the
Department of Paediatric Surgery, The Children's Hospital, Pakistan Institute of Medical Sciences
(PIMS), Islamabad from March 2004 to March 2005. Patients and Methods: All neonates with
oesophageal atresia (EA) and tracheo-oesophageal fistula (TEF) during the study period were included
in the study. Patients having isolated EA were excluded. A total of 80 patients were included in the
study. Patients were received from the emergency department, OPD and Neonatal ICU. Diagnosis was
confirmed by passing a radio opaque orogastric tube. Investigations were done to look for other
associations. After stabilisation, right thoracotomy was performed, fistula was ligated and divided. An
attempt was made to do a primary oesophago-oesopahgostomy. Nasogastric feeding was started on 2nd
post-operative day. A contrast oesophagogram was performed on the 7th postoperative day and having
ruled out leak, oral feeding was started. Results: Out of the total, 33 (41%) survived and 47 (58%)
patients died. Out of 47 deaths 20 (25%) died before surgery and 27 (34%) died after surgery. Mean
follow up period was 6 months. Sixteen (20%) patients had anastomotic leak, 24 (30%) had
anastomotic stricture, and 64 (80%) patients had postoperative pneumonia. Conclusion: We conclude
that proper antenatal check ups will detect the problem early, avoid home deliveries and hence improve
survival. Pneumonitis and septicaemia significantly affect survival. Availability of ICU is one of the
main determinants of survival. The likely cause of high mortality rate in pre-operative patients in our
series is non-availability of NICU due to limited space in our setup.
Keywords: Oesophageal atresia, tracheo-oesophageal fistula, survival, neonates
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