The postoperative complications in esophageal atresia/tracheoesophageal fistula repair: Two institutions experience

Background: Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) represents a spectrum of relatively rare and complex congenital malformations in newborns. It carries a major challenge for the pediatric surgeon in terms of operative intervention and early identification and management of postoperative complications. The short-and long-term postoperative complications are frequently observed during the follow-up period. This study evaluated the results of 14 cases of EA-TEF to determine the outcome of operative repair. Methods: This retrospective cohort study included all newborns with EA-TEF who were operated on and followed up in two institutions, King Abdulaziz Medical City (KAMC) and King Faisal Hospital Research Center (KFSHRC) in Jeddah, during a 5-year period (2015–2019). Data include the patient’s age, gender, birth weight, degree of prematurity, type of tracheoesophageal anomaly, the presence of comorbidities, time of intervention, type of operative intervention, and postoperative complications observed during the follow-up period. Results: The participants included in this study were newborns delivered and operated on at KAMC and KFSHRC. The birth weight was normal >2500 g (64.3%), low birth weight (LBW 1500–2500 g) (28.6%), and extreme low birth weight <1000 g (7.1%). The variants of tracheoesophageal anomalies were Type C (42.9%), Type A (28.6%), and Type E (28.6%). Females were more than males and comorbidity was found in 7 cases. Depending on the type of EA-TEF, the timing of the intervention ranged from 2 to 240 days. Operative interventions were primary anastomosis (35.7%), staged procedure (35.7%), and fistula ligation of Type E (28.6%). Postoperative complications were stricture (50%), gastroesophageal reflux disease (GERD) (28.6%), recurrence (7.1%), tracheomalacia (7.1%), and leak (7.1%). One patient died. All patients with Type C underwent primary anastomosis, except one who underwent a staged operation along with Type A patients. Fistula ligation was achieved in four patients with Type E. The outcomes of patients who received primary anastomosis were stricture (60%), GERD (40%), and recurrence (20%). The patients who underwent staged operation developed strictures (80%), followed by GERD (40.0%), they underwent further fundoplication procedure (40%), tracheomalacia (20%), and leak (20%). GERD developed in 1 of 7 cases (14.3%) who did not have stricture and in 3 of 7 cases (42.9%) who had stricture. Conclusions: EA/TEF is a rare condition associated with various comorbidities. Postoperative complications include stricture, GERD, recurrence, tracheomalacia, and leak. Further studies analyzing and describing postoperative management in detail are required.