Outcomes in esophageal atresia and tracheoesophageal fistula

J Pediatr Surg. 2003 Dec;38(12):1726-9. doi: 10.1016/j.jpedsurg.2003.08.039.


Background/purpose: The purpose of this analysis was to investigate outcomes in newborns with esophageal atresia (EA) or tracheoesophageal fistula (TEF) with respect to prognostic classifications and complications.

Methods: Charts of all 144 infants with EA/TEF treated at British Columbia Children's Hospital (BCCH) from 1984 to 2000 were reviewed. Patient demographics, frequency of associated anomalies, and details of management and outcomes were examined.

Results: Applying the Waterston prognostic classification to our patient population, survival rate was 100% for class A, 100% for class B, and 80% for class C. The Montreal classification survival rate was 92% for class I and 71% for class II (P =.08). Using the Spitz classification, survival rate was 99% for type I, 84% for type II, and 43% for type III (P <.05). The Bremen classification survival rate was 95% "without complications" and 71% "with complications." Complications included stricture (52%), gastroesophageal reflux (31%), anastomotic leakage (8%), recurrent fistula (8%), and pneumonia (6%). Seventeen patients underwent fundoplication for gastroesophageal reflux, 16 pre-1992 and one post-1992.

Conclusions: Comparing the major prognostic classifications, the Spitz classification scheme was found to be most applicable. In our institution, the trend in management of gastroesophageal reflux after repair of EA/TEF has moved away from fundoplication toward medical management.

MeSH terms

  • Abnormalities, Multiple / mortality
  • Esophageal Atresia / classification*
  • Esophageal Atresia / mortality
  • Esophageal Atresia / surgery
  • Female
  • Fundoplication
  • Humans
  • Infant, Newborn
  • Male
  • Postoperative Complications
  • Prognosis
  • Survival Rate
  • Tracheoesophageal Fistula / classification*
  • Tracheoesophageal Fistula / mortality
  • Tracheoesophageal Fistula / surgery
  • Treatment Outcome