30-year follow-up of the original Sulamaa (end-to-side) operation for oesophageal atresia.

Between 1949 and 1955 end-to-side anastomosis was performed on 26 patients with oesophageal atresia at Helsinki Children's Hospital. During the same period, 28 patients with oesophageal atresia were operated by the end-to-end method. The re-fistula rate and rate of anastomotic leaks did not differ significantly. After 30 years, four patients operated with the end-to-side method were alive and were re-examined. All four are well and lead a normal life. Three have no symptoms and one patient has minor swallowing symptoms. In oesophagograms two patients had grossly pathological peristalsis and two had slightly disturbed oesophageal motility. For comparison five patients operated with the end-to-end technique in 1951-1956 were also re-examined. One was symptom-free, the other four had minor symptoms on swallowing, but all were satisfied with their oesophagus. Two oesophagograms showed slight dysfunction, two were moderately pathologic and one was grossly pathologic. The oesophagograms correlated poorly with the subjective symptoms. The long-term prognosis of both end-to-side and end-to-end operated patients with oesophageal atresia seems equally good, all the re-examined patients leading a normal life.