Predictors of the Performance of Early Antireflux Surgery in Esophageal Atresia

J Pediatr. 2019 Aug;211:120-125.e1. doi: 10.1016/j.jpeds.2019.03.045. Epub 2019 May 6.

Abstract

Objective: To identify predictors of and factors associated with the performance of antireflux surgery during the first year of life in children born with esophageal atresia.

Study design: All patients were included in a French registry for esophageal atresia. All 38 multidisciplinary French centers completed questionnaires about perinatal characteristics and one-year outcome for children born with esophageal atresia.

Results: Of 835 infants with esophageal atresia born in France from 2010 to 2014, 682 patients, excluding those with long-gap esophageal atresia, were included. Three patients had type I, 669 had type III, and 10 had type IV esophageal atresia. Fifty-three children (7.8%) received fundoplication during the first year of life. The median age at the time of the end-to-end esophageal anastomosis was 1.1 day (range 0-15). Multivariate analysis identified three perioperative factors that predicted the need for early antireflux surgery: anastomotic tension (P = .004), associated malformations (P = .019), and low birth weight (P = .018). Six other factors, measured during the first year of life, were associated with the need for antireflux surgery: gastroesophageal reflux (P < .001), anastomotic stricture (P < .001), gastrostomy (P < .001), acute life-threatening event (P = .002), respiratory complications (P = .045), and poor nutritional status (P < .001).

Conclusions: Gastroesophageal reflux disease, low birth weight, poor nutrition, and surgical anastomosis difficulties predicted the performance of antireflux surgery in the first year of life in infants with esophageal atresia.

Keywords: antireflux surgery; esophageal atresia; fundoplication; gastroesophageal reflux disease; infant.

MeSH terms

  • Anastomosis, Surgical / adverse effects
  • Constriction, Pathologic
  • Esophageal Atresia / classification
  • Esophageal Atresia / surgery*
  • Female
  • France
  • Fundoplication*
  • Gastroesophageal Reflux / surgery
  • Gastrostomy
  • Humans
  • Infant
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Male
  • Multivariate Analysis
  • Nutritional Status
  • Registries