Hanaa H Banjar1, Saleh I Al-Nassar. 1. Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, PO Box 3354, MBC-58, Riyadh 11211, Kingdom of Saudi Arabia. hanaa@kfshrc.edu.sa
Abstract
OBJECTIVE: This study represents the experience of a tertiary care center in the Kingdom of Saudi Arabia (KSA) on the long-term effect on the lungs of esophageal atresia (EA) and tracheoesophageal fistula repair (TEF), and to emphasize the magnitude of gastroesophageal reflux (GER) post-EA or post-TEF repair. METHODS: A retrospective review of all patients referred to the pulmonary clinic with EA/TEF or re-operative evaluations from the period 1993-2004 at King Faisal Specialist Hospital and Research Centre, Riyadh, KSA. RESULTS: Forty-one patients with confirmed EA/TEF (26 males and 15 females) were included in the study. Congenital anomalies were associated in 28 (68%). Gastroesophageal reflux developed in 39 (95%) of patients, 24 (59%) needed Nissen fundoplication. Esophageal stricture that required more than 3 dilations developed in 16 (46%) patients, esophageal dysmotility in 37 (90%) and hiatal hernia in 11 (27%). Pulmonary complications developed in >70% of the patients including persistent atelectasis, chronic aspiration pneumonia, asthma and chronic lung disease that required oxygen for more than one month. Tracheomalacia in 12 (29%) and bronchiectasis in 7 (17%). Eighty-eight percent of patients who were able to do pulmonary function test showed abnormal values of moderate obstructive and restrictive lung disease. CONCLUSION: Pulmonary complications cause significant and prolonged morbidities post EA/TEF repair. Gastroesophageal reflux is a common complication after EA/TEF repair and causes significant morbidity that needs a prolonged follow up. Patients with GER may need Nissen fundal plication to improve respiratory problems.
OBJECTIVE: This study represents the experience of a tertiary care center in the Kingdom of Saudi Arabia (KSA) on the long-term effect on the lungs of esophageal atresia (EA) and tracheoesophageal fistula repair (TEF), and to emphasize the magnitude of gastroesophageal reflux (GER) post-EA or post-TEF repair. METHODS: A retrospective review of all patients referred to the pulmonary clinic with EA/TEF or re-operative evaluations from the period 1993-2004 at King Faisal Specialist Hospital and Research Centre, Riyadh, KSA. RESULTS: Forty-one patients with confirmed EA/TEF (26 males and 15 females) were included in the study. Congenital anomalies were associated in 28 (68%). Gastroesophageal reflux developed in 39 (95%) of patients, 24 (59%) needed Nissen fundoplication. Esophageal stricture that required more than 3 dilations developed in 16 (46%) patients, esophageal dysmotility in 37 (90%) and hiatal hernia in 11 (27%). Pulmonary complications developed in >70% of the patients including persistent atelectasis, chronic aspiration pneumonia, asthma and chronic lung disease that required oxygen for more than one month. Tracheomalacia in 12 (29%) and bronchiectasis in 7 (17%). Eighty-eight percent of patients who were able to do pulmonary function test showed abnormal values of moderate obstructive and restrictive lung disease. CONCLUSION:Pulmonary complications cause significant and prolonged morbidities post EA/TEF repair. Gastroesophageal reflux is a common complication after EA/TEF repair and causes significant morbidity that needs a prolonged follow up. Patients with GER may need Nissen fundal plication to improve respiratory problems.