BACKGROUND: Primary surgical repair forms the definitive treatment of esophageal atresia. Long-term survival rates and patient morbidity after repair still remains a problem especially in developing countries. Postoperative morbidity depends on the incidence of anastomotic leak, gastroesophageal reflux, strictures, and recurrent fistula formation. PURPOSE: To describe the frequency of different findings at fluoroscopic evaluation of postoperative esophagus in children following repair for esophageal atresia with or without tracheo-esophageal fistula. MATERIAL AND METHODS: Hospital records and upper gastrointestinal contrast studies of 210 patients following repair for esophageal atresia with or without a tracheo-esophageal fistula were reviewed by two pediatric radiologists. All children underwent surgery in the first few days of life (days 1-6). Fluoroscopic contrast study was performed at various intervals after surgery in children with suspected complications or feeding difficulties. RESULTS: Images from upper gastrointestinal contrast studies of 210 patients (126 boys, 84 girls) were evaluated and recorded. Findings were recorded as normal postoperative appearances (37.1%) and complications/sequelae, which included strictures (33.8%), minor and major leaks (11.9%), reflux (13.8%), motility problems (7.1%), persistent fistula (3.8%), diverticulae formation (4.7%), and hiatus hernia (2.1%). CONCLUSION: Strictures, leaks, and reflux are the most common complications of esophageal atresia repair. Knowledge of various postoperative appearances would be useful for planning an appropriate management strategy in these children.
BACKGROUND: Primary surgical repair forms the definitive treatment of esophageal atresia. Long-term survival rates and patient morbidity after repair still remains a problem especially in developing countries. Postoperative morbidity depends on the incidence of anastomotic leak, gastroesophageal reflux, strictures, and recurrent fistula formation. PURPOSE: To describe the frequency of different findings at fluoroscopic evaluation of postoperative esophagus in children following repair for esophageal atresia with or without tracheo-esophageal fistula. MATERIAL AND METHODS: Hospital records and upper gastrointestinal contrast studies of 210 patients following repair for esophageal atresia with or without a tracheo-esophageal fistula were reviewed by two pediatric radiologists. All children underwent surgery in the first few days of life (days 1-6). Fluoroscopic contrast study was performed at various intervals after surgery in children with suspected complications or feeding difficulties. RESULTS: Images from upper gastrointestinal contrast studies of 210 patients (126 boys, 84 girls) were evaluated and recorded. Findings were recorded as normal postoperative appearances (37.1%) and complications/sequelae, which included strictures (33.8%), minor and major leaks (11.9%), reflux (13.8%), motility problems (7.1%), persistent fistula (3.8%), diverticulae formation (4.7%), and hiatus hernia (2.1%). CONCLUSION: Strictures, leaks, and reflux are the most common complications of esophageal atresia repair. Knowledge of various postoperative appearances would be useful for planning an appropriate management strategy in these children.
Authors: V Hochart; P Verpillat; C Langlois; C Garabedian; J Bigot; V Houfflin Debarge; R Sfeir; F E Avni Journal: Eur Radiol Date: 2014-10-11 Impact factor: 5.315