RESUMO
BACKGROUND DATA: EA is the most frequent congenital esophageal malformation. Long gap EA remains a therapeutic challenge for pediatric surgeons. A case case-control prospective study from a multi-institutional national French data base was performed to assess the outcome, at age of 1 and 6 years, of long gap esophageal atresia (EA) compared with non-long gap EA/tracheo-esophageal fistula (TEF). The secondary aim was to assess whether initial treatment (delayed primary anastomosis of native esophagus vs. esophageal replacement) influenced mortality and morbidity at ages 1 and 6 years. METHODS: A multicentric population-based prospective study was performed and included all patients who underwent EA surgery in France from January 1, 2008 to December 31, 2010. A comparative study was performed with non-long gap EA/TEF patients. Morbidity at birth, 1 year, and 6 years was assessed. RESULTS: Thirty-one patients with long gap EA were compared with 62 non-long gap EA/TEF patients. At age 1 year, the long gap EA group had longer parenteral nutrition support and longer hospital stay and were significantly more likely to have complications both early post-operatively and before age 1 year compared with the non-long gap EA/TEF group. At 6 years, digestive complications were more frequent in long gap compared to non-long gap EA/TEF patients. Tracheomalacia was the only respiratory complication that differed between the groups. Spine deformation was less frequent in the long gap group. There were no differences between conservative and replacement groups at ages 1 and 6 years except feeding difficulties that were more common in the native esophagus group. CONCLUSIONS: Long gap strongly influenced digestive morbidity at age 6 years.
Assuntos
Atresia Esofágica , Fístula Traqueoesofágica , Recém-Nascido , Criança , Humanos , Lactente , Pré-Escolar , Atresia Esofágica/complicações , Estudos de Casos e Controles , Estudos Prospectivos , Fístula Traqueoesofágica/epidemiologia , Fístula Traqueoesofágica/cirurgia , Fístula Traqueoesofágica/complicações , Resultado do Tratamento , Estudos RetrospectivosRESUMO
BACKGROUND: The aim of the present national prospective population-based study was to assess the early morbidity of esophageal atresia (EA). METHODS: All 38 multidisciplinary French centers that care for patients with EA returned a specific questionnaire about the 1-year outcome for each patient. This information was centralized, checked, and entered into a database. RESULTS: From the total population of 307 EA patients born in 2008 and 2009, data about the 1-year outcome were obtained from 301 (98%) patients, of whom 4% were lost to follow-up and 5% died. Medical complications occurred in 34% of the patients: anastomotic leaks (8%), recurrent tracheoesophageal fistula (4%), and anastomotic stenosis (22%); all of the latter group needed dilation (median, 2 dilations/patient). A new hospitalization was required for 59% of patients (2.5 hospitalizations/patient) for digestive (52%) or respiratory (48%) reasons. Twelve percent of patients required antireflux surgery at a median age of 164 days (range, 33-398 days), and 1% underwent an aortopexy for severe tracheomalacia. The weight/age Z-score was -0.8 (range, -5.5 to 3.7 months) at 12 months. Fifteen percent of patients were undernourished at 12 months of age, whereas 37% presented with respiratory symptoms and 15% had dysphagia at the last follow-up. Significant independent factors associated with medical complications were anastomotic esophageal tension (p = .0009) and presence of a gastrostomy (p = .0002); exclusive oral feeding at discharge was associated with a decreased risk of complications (p = .007). CONCLUSIONS: Digestive and respiratory morbidities remain frequent during the first year of life and are associated with difficult anastomosis and lack of full oral feeding.
Assuntos
Atresia Esofágica/diagnóstico , Atresia Esofágica/epidemiologia , Vigilância da População , Sistema de Registros , Atresia Esofágica/terapia , Feminino , Seguimentos , França/epidemiologia , Hospitalização/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Vigilância da População/métodos , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: A prospective national register was established in 2008 to record all new cases of live-birth newborns with esophageal atresia (EA). This epidemiological survey was recommended as part of a national rare diseases plan. METHODS: All 38 national centers treating EA participated by completing for each patient at first discharge a questionnaire validated by a national committee of experts. Data were centralized by the national reference center for esophageal anomalies. Quantitative and qualitative analyses were performed, with P-values of less than 0.05 considered statistically significant. Results of the 2008-2009 data collection are presented in this report. RESULTS: Three hundred seven new living cases of EA were recorded between January 1, 2008, and December 31, 2009. The male/female sex ratio was 1.3, and the live-birth prevalence of EA was 1.8 per 10,000 births. Major characteristics were comparable to those reported in the literature. Survival was 95%, and no correlation with caseload was noted. CONCLUSIONS: Epidemiologic surveys of congenital anomalies such as EA, which is a rare disease, provide valuable data for public health authorities and fulfill one important mission of reference centers. When compared with previous epidemiological data, this national population-based registry suggests that the incidence of EA remains stable.
Assuntos
Atresia Esofágica/epidemiologia , Doenças do Prematuro/epidemiologia , Anormalidades Múltiplas/epidemiologia , Adolescente , Adulto , Peso ao Nascer , Estudos de Coortes , Terapia Combinada , Atresia Esofágica/diagnóstico , Atresia Esofágica/tratamento farmacológico , Atresia Esofágica/cirurgia , Feminino , França/epidemiologia , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/cirurgia , Masculino , Idade Materna , Pessoa de Meia-Idade , Poli-Hidrâmnios/epidemiologia , Vigilância da População , Gravidez , Diagnóstico Pré-Natal , Prevalência , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Inquéritos e Questionários , Taxa de Sobrevida , Carga de Trabalho , Adulto JovemRESUMO
OBJECTIVE: The Snodgrass urethroplasty, described in 1994 for the treatment of distal hypospadias, has very rapidly become a popular technique. However, incision of the urethral plate could be associated with a risk of stenosis of the neourethra. We present our preliminary results with this technique. MATERIALS AND METHODS: Fifty two patients (47 distal forms and 5 midshaft forms) were operated according to this technique. Twenty five of these patients were reviewed with a follow-up of 18 months, and uroflowmetry was performed in 20 of them. Only the records of the other 27 patients were reviewed. RESULTS: The meatus is apical and oval and the glans is conical. There is no residual chordee. Early in our experience, we observed 13% of fistulas and 4% of stenoses. Four patients presented uroflowmetry results below the curve of the 5th percentile, but were completely asymptomatic. CONCLUSIONS: The results of this technique are excellent. With experience, our complication rate has been markedly decreased by performing deeper incision of the urethral plate. The risk of stenosis is theoretical rather than practical.