Transpleural end-to-end repair of esophageal atresia and tracheoesophageal fistula.

Successful surgery for esophageal atresia and tracheoesophageal fistula is a relatively recent development, and progress has been rapid over the past 10 years. Because the surgical technique is still controversial, the authors reviewed their experience in treating 38 infants with the condition. Transpleural end-to-end repair was carried out in all cases. In 21 cases a two-layer repair was done and in 17 a one-layer repair. After 10 days, if no anastomotic leak was detected radiologically, esophagoscopy and dilatation at the anastomotic site were performed; dilatation was carried out routinely once or twice thereafter when necessary. The most common complication was stricture of the anastomosis (eight cases), which required more than the three dilatations routinely performed. Other complications were recurrent fistula (two patients) and anastomotic leak (two patients). Six of the 38 infants died; all had other serious anomalies. The results overall compared favourably with those of other published series. The authors conclude that end-to-end repair using a transpleural approach is a safe and effective method for surgical repair of esophageal atresia and tracheoesophageal fistula. The approach provides excellant exposure so that anastomotic tension can be evaluated, thus allowing improved mobilization of the esophagus. Both factors contribute to a low frequency of anastomotic complications.