Anwar Arain, Farhat Mirza, Jamshed Akhtar, Soofia Ahmed, Iftikhar Ahmed Jan.
Esophageal atresia and tracheo-esophageal fistula: an experience from a developing country.
J Surg Pak Jan ;12(1):2-7.

Objective: To evaluate the various factors influencing the survival of neonates with oesophageal atresia with distal tracheo-oesophageal fistula (EA with TEF). Study Design: A descriptive case series. Place and Duration of study: Department of Paediatric Surgery, National Institute of Child Health, Karachi from January 2003 to December 2003. Patients & Methods: A descriptive case series spanned over one year was conducted at the Department of Paediatric Surgery, National Institute of Child Health, Karachi. The baby`s condition was classified according to Waterston`s classification. All patients who survived were discharged when they were stable and fit for nursing at home. A routine follow up was advised, initially monthly and later at greater intervals. Results: During one year period 45 patients of oesophageal atresia with distal tracheo-oesohageal fistula were managed. Among these twenty seven (60%) were male and eighteen (40%) female babies. The age at presentation ranged between 3 hours to 20 days with a median age 4 days The weight at presentation ranged between 1.2 kg to 3.5 kg with a mean of 2.3 + 0.5 kg. According to Waterston classification nine (20%) of these were in group-A, twenty-four (53%) in group-B and twelve (27%) in group-C. Six (13%) died preoperatively. In nine patients circular myotomy was done due to long gap. Postoperatively five patients needed ventilatory support. Postoperative course was uneventful in fifteen patients Twenty four (61%) patients developed minor and major complications. Postoperatively thirteen (28.8%) patients died. Cause of death was mainly sepsis. The over all mortality was 42.2%. Conclusions: A high overall mortality is of concern but post operative survival of about 66.6% (overall 57.8%) is encouraging. Early referral seems to be an important preventable factor for which awareness program at primary health care level is to be stressed upon.

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