Long-gap Esophageal Atresia. Growth, Nutritional Status and Morbidity 2-10 Years after Operation

Authors: J. Kalousová;  J. Stýblová;  J. Šnajdauf;  R. Fryč;  K. Pýcha;  O. Petrů;  D. Pachmannová;  L. Tomášek 1
Authors‘ workplace: Klinika dětské chirurgie 2. LF UK a FN Motol, Subkatedra dětské chirurgie IPVZ, Praha přednosta prof. MUDr. J. Šnajdauf, DrSc. Státní ústav radiační ochrany, Praha1 ředitel ing. R. Filgas
Published in: Čes-slov Pediat 2004; (5): 219-224.


Aim of study:
To evaluate nutritional status, feeding, gastrointestinal and respiratory problems and quality oflife of children operated on for long - gap (LG) esophageal atresia (EA) and compare results of several surgicaltechniques.Methods: Children operated on for EA in 1992 - 2001 were included in the study. Data about feeding problems,gastrointestinal and respiratory symptoms and quality of life were collected by a questionnaire filled in by parentsof children with EA. Nutritional status evaluation was based on anthropometrical parameters: height, weight, headand arm circumference and skinfold thickness: triceps, subscapular, suprailiacal. Children with LG were dividedinto subgroups according to surgical technique - primary anastomosis (PA), delayed anastomosis (DA) andesophageal substitution - gastric transposition (GT). Children without long - gap atresia with primary anastomosisserved as a control group.Results: 37.7% children after operation for EA have feeding difficulties, 26.1% have postprandial problems.Children with LG have higher incidence of nausea, dyspnoea, diarrhea. The incidence of respiratory problems is30.4%. Dyspnoea without and after exercise (25 and 28.6%, respectively) and during the night (23.8%) are morefrequent after LG atresia. This is also true for all subgroups of LG atresia - PA, DA, GT. The average height (-0.56 SD),weight (-0.82 SD), head (-0.51 SD) and arm circumference (-0.81 SD) are below the population average. ChildrenwithDAhave the worst results in the subgroups of LG: height -1.47 SD, weight -1.57 SD. Quality of life is consideredto be good in 69.1%, favorable in 25%, unfavorable in 5.9%. There are no statistically significant differences inquality of life evaluation in the subgroups.Conclusion: According to the results of long term follow up delayed anastomosis seems to be the least successfulmethod in the treatment of long - gap esophageal atresia.

Key words:
long-gap esophageal atresia, esophageal substitution, primary anastomosis, delayed anastomosis,gastroesophageal reflux, nutritional status

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Neonatology Paediatrics General practitioner for children and adolescents
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