[Modern trends in the treatment of esophageal atresia].

Results in the treatment of oesophageal atresia have greatly improved in the last 20 years. In an increasing number of patients it is possible to practice primary surgical correction at birth. From December '82 to December '95, 64 neonates with oesophageal atresia ranging in weight from 1.2 to 3.8 kg were observed. Fifty-eight neonates had type III atresia, four had type I atresia and two presented a rare membranous atresia with a long longitudinal intramural fistula. Fifty-four associated malformations were present in thirty-five neonates (55%). Congenital cardiopathies were the most frequent malformations followed by ano-rectal, skeletal and urinary malformations. According to the classification proposed by Waterston, 35% of the neonates were Class A, 33% Class B, and 32% Class C. Three neonates with polymalformations died before surgical treatment. Our trend is to attempt, when possible, primary correction using an extrapleural approach, even in the presence of a long gap. Oesophageal anastomosis was performed in 51 patients (80%). Gastrostomy was never performed routinely but only in selected cases. Early post-operative complications occurred in 22.5% of the cases. Gastroesophageal reflux, registered in 11 cases, was treated surgically in 4 cases. All 13 cases of post-anastomotic stenosis were treated with cycles of dilatations. The overall survival rate in 64 patients was 80% (96% in Class A; 86% in Class B, 55% in Class C). Of the 51 patients who underwent oesophageal anastomosis only 3 died, one because of the risk category according to Waterston. Survival is related more to the presence of severe multiple associated malformations, rather than bronchopneumonic complications of birth weight.