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Eur J Pediatr Surg 2019; 29(01): 039-048
DOI: 10.1055/s-0038-1668150
Original Article
Georg Thieme Verlag KG Stuttgart · New York

State of Play: Eight Decades of Surgery for Esophageal Atresia

Julia Zimmer
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
,
Simon Eaton
2   Department of Pediatric Surgery, University College London, Institute of Child Health, London, United Kingdom
,
Louise E. Murchison
2   Department of Pediatric Surgery, University College London, Institute of Child Health, London, United Kingdom
,
Paolo De Coppi
3   Stem Cells and Regenerative Medicine, DBC, UCL Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
,
Benno M. Ure
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
,
Carmen Dingemann
1   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
› Author Affiliations
Further Information

Publication History

15 May 2018

27 June 2018

Publication Date:
15 August 2018 (online)

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Abstract

Aim Surgical expertise and advances in technical equipment and perioperative management have led to enormous progress in survival and morbidity of patients with esophageal atresia (EA) in the last decades. We aimed to analyze the available literature on surgical outcome of EA for the past 80 years.

Materials and Methods A PubMed literature search was conducted for the years 1944 to 2017 using the keywords “esophageal/oesophageal atresia,” “outcome,” “experience,” “management,” and “follow-up/follow up.” Reports on long-gap EA only, non-English articles, case reports, and reviews without original patient data were excluded. We focused on mortality and rates of recurrent fistula, leakage, and stricture.

Results Literature search identified 747 articles, 118 manuscripts met the inclusion criteria. The first open end-to-end anastomosis and fistula ligation was reported in 1941. Thoracoscopic fistula ligation and primary anastomosis was performed first in 2000. Reported mortality rate decreased from 100% before 1941 to 54% in 1950 to 1959, 28% in 1970 to 1979, 16% in 1990 to 1999, and 9% nowadays. Rates of recurrent fistula varied over time between 4 and 9%. Leakage rate remained stable between 11 and 16%. However, stricture rate increased from 25 to 38%.

Conclusion Including a full range of articles reflecting the heterogeneity of EA, mortality rate significantly decreased during the course of 80 years. Along with the decrease in mortality, there is a shift to the importance of major postoperative complications and long-term morbidity regardless of surgical technique.

Keywords

esophageal atresia - outcome - surgical techniques - mortality rate - long-term morbidity
 

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