Delayed primary anastomosis in poor-risk patients with esophageal atresia associated with tracheoesophageal fistula.

Twelve patients with esophageal atresia with tracheoesophageal fistula (TEF) who were treated with delayed primary anastomosis were reviewed. All patients except two were classified as Waterston's group C, for whom multiple staged procedures usually can be considered. Gastrostomy for decompression was performed as the initial operation shortly after admission and adequate nutritional support was provided by a transpyloric or jejunostomy tube. Extrapleural division of the TEF and esophagoesophagostomy were delayed until these operations were considered safe to perform. Delayed primary anastomosis was done at varying ages from the 11th day of life to the 150th day. Eleven patients survived. It is concluded that the therapeutic program consisting of gastrostomy, enteral feeding and delayed division of TEF and esophagoesophagostomy is useful in treating poor-risk patients and should replace multiple staged procedures.