Oesophageal atresia and tracheo-oesophageal fistula: review of a 10-year personal experience.
Eleven neonates with oesophageal atresia and distal fistula were managed between July 1977 and January 1987. The male:female ratio was 1.2:1. The patients were aged between 1 to 14 days (median 7 days) and weighed 1.85 to 3.10 kg (mean 2.6 kg) at presentation. Associated anomalies were present in 5, pneumonia in 4 and uraemia (mean serum urea of 88 mg%) in all patients. A primary repair and simultaneous gastrostomy (omitted in 1) was done for all cases. There were 5 operative deaths. Fifteen postoperative complications occurred in 10 patients; including septicaemia in 3, wound infection in 3, anastomotic leak in 1 and tracheal mucus plug in 1. Statistical analysis indicated no difference between survivors and nonsurvivors on the basis of age, weight, degree of uraemia or presence of pneumonia. One of the 6 survivors (now 5 years after surgery) required bouginage after 26 months and has remained asymptomatic; the other 5 are well and without symptoms 3 to 11 months postoperative. The most significant determinants of survival are the effectiveness of pre- and postoperative managements of patients.