Anterior Flap Repair Of Oesophageal Atresia: A 16-Year Evaluation

Abstract

The Aim Of The Study Was To Evaluate The Outcome Of Primary Repair Of Oesophageal Atresia (Oa)/Tracheo-Oesophageal (Tof) Using An Anterior Flap From The Upper Pouch To Relieve Tension On The Anastomosis. Of 66 Patients With Oa/Tof Managed In This Institution In The Period 1977-1993, Only 1 (1.5%) Had A Colonic Interposition. There Were 15 (10 Long-Gap Oa) Primary Repairs With An Anterior Flap. Median Follow-Up Was 2 Years (Range 11 Months-16 Years). Complications Included Anastomotic Leaks In 4 (27%), Anastomotic Strictures In 13 (87%), Of Which 2 (13.3%) Required Resection, Gastro-Oesophageal Reflux In 9 (60%), Of Which 3 (20%) Required Fundoplication, Recurrent Tof In 2 (14%), And Oesophageal Incoordination In 6 (40%). Median Hospital Stay Was 77 Days (Range 18-240 Days). There Were 3 Late Deaths (12, 12, 14 Months). Of 12 Survivors, 8 (66.7%) Achieved Normal Growth. In Addition, 3 Patients Had A Myotomy As Well As A Flap (Anastomotic Leak 2, Stricture 3). We Conclude That The Anterior Flap Technique For Repair Of Oa/Tof Reduces The Need For Oesophageal Replacement. There Is Considerable Morbidity Associated With Its Use In These High-Risk Patients, But A Satisfactory Outcome Can Be Achieved In Long-Term Survivors.