ESOPHAGEAL ATRESIA - TRAGEDIES AND TRIUMPHS OVER 2 DECADES IN A DEVELOPING-COUNTRY

Citation
Ak. Sharma et al., ESOPHAGEAL ATRESIA - TRAGEDIES AND TRIUMPHS OVER 2 DECADES IN A DEVELOPING-COUNTRY, International surgery, 78(4), 1993, pp. 311-314
Citations number
NO
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Surgery
Journal title
ISSN journal
0020-8868
Volume
78
Issue
4
Year of publication
1993
Pages
311 - 314
Database
ISI
SICI code
0020-8868(1993)78:4<311:EA-TAT>2.0.ZU;2-P
Abstract
During a period of two decades, 1972-1991, 303 patients with esophagea l atresia and/or tracheo-esophageal fistula were treated at the depart ment of Pediatric Surgery, SMS Medical College, Jaipur, India. More th an half of our patients fall into Waterston's risk category C. To eval uate the improvement in our results, the patients were divided into fo ur phases of 5 years each. Over the period of observation, the inciden ce of new cases as well as the number of associated anomalies has cons iderably increased. With time, more patients are being diagnosed and r eferred early for treatment. This has resulted in more patients being treated by primary repair with or without a gastrostomy. Extrapleural approach and single layer end-to-end anastomosis has been practised in all cases. Results have shown a steady improvement primarily because of early recognition, improved perioperative care and newer antibiotic s. Although postoperative pulmonary complications and anastomotic leak have shown a decreasing trend, but the presence of severe associated anomalies, pulmonary complications and sepsis still remain the major k illers in our set-up. Although our results may not match those from th e developed countries, we have still come a long way, improving our ov erall survival rate of 4.6% in 1972-76 to 45.7% in 1987-91. Through th e present article, we wish to highlight the practical problems faced i n the management of these patients in underprivileged developing count ries.