WOFAPS 2025 8th World Congress of Pediatric Surgery

AIM:

Following oesophageal atresia /tracheo-oesophageal fistula (OA/TOF) repair, the standard leak rate reported is 6%–15%, and stricture rate 40%–72%. There is a global quest for surgical innovations to drive down these complication rates.

METHODS:

A prospectively maintained database of a single surgeon's patients who had OA repair from 1995 to 2016 was reviewed. Two distinct innovations were implemented:

(1) Adequate or generous mobilization of the lower oesophageal pouch.

(2) A 2–5 mm slit in distal oesophagus to widen its circumference.

RESULTS:

Forty‑three patients with OA/TOF were reviewed. Of those, 40 underwent primary repair. The median follow‑up was 12.5 years (range 4–26 years).

There were no anastomotic leaks and only 8 (20%) patients developed anastomotic strictures requiring dilations (1–5 dilations/patient).

One patient had a recurrent tracheo-oesophageal fistula. At latest follow‑up, 35 (87.5%) patients had normal oral feeding, while 1 (2.5%) patient had occasional food sticking episodes. Four syndromic patients (10%) were on jejunal/gastrostomy feeding.

CONCLUSION:

An adequate or generous mobilization of the distal oesophageal pouch, together with a 2–5 mm slit in the distal oesophagus, achieves a tension‑free and wide anastomosis. We believe that oesophageal ends that lie comfortably together are less likely to leak or to stenose.

All anastomoses eventually narrow, sometimes just a little, and starting on a higher scale with a small slit, helps. Sometimes the circumference of the distal oesophagus may be only 8 mm, and in such patients, even a tiny 2 mm slit increases the circumference by 4 mm resulting in a 1/3 increase in the circumference of the organ!

These innovations contributed to a substantially lower complication rate over a 22‑year period – no leaks and only 20% stricture.

Published earlier in a regional journal.