P0751 OUTCOME OF CHILDREN AFTER SURGICAL REPAIR FOR OESOPHAGEAL ATRESIA:

Introduction: Children with oesophageal atresia who underwent repair during neonatal period have an excellent short term prognosis. However the first years of life can be associated with many gastrointestinal, respiratory and nutritional disorders. The aim of this study was to determine the frequency of these complications. Methods: Medical records of 63 children presenting with oesophageal atresia over a 10-year period (from January 1993 to December 2002) were retrospectively reviewed. Study parameters included dysphagia, gastrooesophageal reflux disease, anastomotic stricture, body mass index (BMI), tracheomalacia, asthma, recurrent respiratory infections. Results: Sixty-three children (24 girls – 39 boys) were identified; the mean follow-up was 5.6 years (± 2.4 ); mean gestional age at delivery was 37.5 weeks (± 2.3) and the mean birthweight was 2600g (± 500g). The number of children with a type 3 atresia was 58 (92%), and 30 (47%) had associated congenital malformations (cardiac =13, renal=8, musculoskeletal =17, digestive = 6). A primary repair was performed in 59 (94%) with an anastomotic tension for 24 of them. Other children have had a delayed repair (2 cases) or colonic interposition later (2 cases). Forty-six children (76%) had respiratory complications: tracheomalacia (68%) with associated laryngomalacia (10%), asthma with a daily treatment (36%), recurrent respiratory infections (56%) and fistula recurrence (5%). Forty-four patients (73%) had gastro-intestinal disorders: gastro-oesophagal reflux (53%), anastomotic strictures requiring endoscopic dilatations (28%), feeding troubles (58%), food impaction (11%). Six children (10%) underwent an antireflux procedure (Nissen fundoplication) which the mean age was 1.1 year (± 0.6). Nutritional evaluation showed a mean BMI at 42th percentile (± 26). Two babies died: one case of a sudden infant death and one case of a severe tracheomalacia. Conclusion: The morbidity of oesophageal atresia after surgical treatment is very high. Consequently, we recommend an extended specialized follow-up for this population.