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

Overview

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