13 pairs of ribs--a predictor of long gap atresia in tracheoesophageal fistula.

Results of treatment of tracheoesophageal fistula (TEF) have improved over the years. However, long gap atresias continue to be a problem and require modification in the conventional operation. Preoperative diagnosis of a long gap atresia in a case of TEF is difficult, and often the defect is noted only at thoracotomy, thus necessitating multiple intraoperative changes in the position of the neonate. In the past 5 years the authors have treated 61 cases of TEF. Of these, 12 had a long gap atresia. Nine of these 12 patients had 13 pairs of ribs. None of the patients with a short gap atresia had 13 pairs of ribs. Hence, the presence of 13 pairs of ribs is a good indicator of long gap atresia. In a child who has TEF with 13 pairs of ribs, suitable modifications in operative procedure can be planned. The report also discusses the possible embryological basis of this association.